Information Collection

Leads from SATH eligible respondent

IC 180714 under ICR 200706-0920-010 · OMB 0920-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0406 can be found here:

Documents and Forms

Document Name Document Type
Attachment 2.doc Instruction
Attachment 4i.doc Recruitment or verification methods IC Document
Attachment 5.doc Thank you letter IC Document
Attachment 6.doc Additional backup material IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Leads from SATH eligible respondent	Agency IC Tracking Number:

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
Instruction			Attachment 2.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,500	0	0	0	0	0
Annual IC Time Burden (Hours)	75	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Recruitment or verification methods	Attachment 4i.doc	06/05/2007
Thank you letter	Attachment 5.doc	06/05/2007
Additional backup material	Attachment 6.doc	06/05/2007

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