Yellowstone National Park Backcountry Survey [Web-based Version]

Survey of Illness and Injury Among Backcountry Users in Yellowstone National Park

Documents and Forms

Document Name Document Type
Yellowstone National Park Backcountry Survey [Web-based Version] Form and Instruction
Yellowstone National Park Backcountry Survey Appendix M_Yellowstone Study Questionnaire - Internet Version_060707.doc Form and Instruction
Appendix K_Yellowstone Study Introductory Email_060607.doc Introductory E-mail IC Document
Appendix L_Yellowstone Study Consent - Internet Version_060707.doc Yellowstone Study Consent IC Document

Information Collection (IC) Details

IC Title:	Yellowstone National Park Backcountry Survey [Web-based Version]	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	Yellowstone National Park Backcountry Survey	Appendix M_Yellowstone Study Questionnaire - Internet Version_060707.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 0920-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 3,423	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	3,423	3,423
Annual IC Time Burden (Hours)	1,712	1,712
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Introductory E-mail	Appendix K_Yellowstone Study Introductory Email_060607.doc	06/13/2007
Yellowstone Study Consent	Appendix L_Yellowstone Study Consent - Internet Version_060707.doc	06/13/2007

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