Information Collection

Consent to Further Contact

IC 43617 under ICR 200706-0920-011 · OMB 0920-0727.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consent to Further Contact	Form and Instruction
Consent-to-Further-Contact Form Appendix G_Yellowstone Study Consent-to-Further-Contact Form_060707.pdf	Form and Instruction
Appendix F_Yellowstone Study Backcountry Permit_060607B.pdf Yellowstone National Park Backcountry Permit	IC Document
Appendix H_Yellowstone Study Introduction Page_060707.doc Yellowstone Study Introduction Page	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Consent-to-Further-Contact Form	Appendix G_Yellowstone Study Consent-to-Further-Contact Form_060707.pdf		No	No	Paper Only

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: 10,138

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,138	4,862	5,276
Annual IC Time Burden (Hours)	338	-1,465	1,803
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Yellowstone National Park Backcountry Permit	Appendix F_Yellowstone Study Backcountry Permit_060607B.pdf	06/13/2007
Yellowstone Study Introduction Page	Appendix H_Yellowstone Study Introduction Page_060707.doc	06/13/2007

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