Information Collection

Follow-up Questionnaire

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Follow-up Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.