Consent to Further Contact

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Consent to Further Contact	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	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 %

	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

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.