Information Collection

Follow-up Questionnaire

IC 179711 under ICR 200704-0920-001 · OMB 0920-0744.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Follow-up Questionnaire	Form and Instruction
Follow-up Questionnaire ATTACHMENT F.followup questionnaire.doc	Form and Instruction
ATTACHMENT I.reminderletter followup.doc Reminder Letter for Follow-up	IC Document
ATTACHMENT J.followup thankyou letter.doc Thank-you for Follow-up Participation	IC Document

IC Title:

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	Follow-up Questionnaire	ATTACHMENT F.followup questionnaire.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 533

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	533	533
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reminder Letter for Follow-up	ATTACHMENT I.reminderletter followup.doc
Thank-you for Follow-up Participation	ATTACHMENT J.followup thankyou letter.doc

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