Information Collection

(EGAPP) - General Survey - att D5

IC 179077 under ICR 200703-0920-005 · OMB 0920-0751.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0751 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
(EGAPP) - General Survey - att D5	Form and Instruction
D5. General Survey ATTACHMENT D General Survey.doc	Form and Instruction

IC Title:

(EGAPP) - General Survey - att D5

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	D5. General Survey	ATTACHMENT D General Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 770

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	770	770
Annual IC Time Burden (Hours)	128	128
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.