Information Collection

Modification to El Paso Tx Survey instrument

IC 181378 under ICR 200707-0920-007 · OMB 0920-0726.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
H-L ATS Questionnaire (All Spanish)_El_Paso.doc	Instruction
H-L ATS Questionnaire (English)_El_Paso.doc	Instruction
H-L ATS Questionnaire tracked changes.doc Instrument with tracked changes	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Instruction			H-L ATS Questionnaire (All Spanish)_El_Paso.doc		Yes	No	Printable Only
Instruction			H-L ATS Questionnaire (English)_El_Paso.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 66 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instrument with tracked changes	H-L ATS Questionnaire tracked changes.doc	07/19/2007

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