Asthma Research Survey

Program Assessment and Evaluations for NIEHS - Asthma Research

Documents and Forms

Document Name Document Type
Form 1 Asthma Research Survey Form and Instruction
1 Asthma Research Survey OMB Attachment 1 Survey.doc Form and Instruction
OMB Attachment 2 Introductory and Follow-up Letters.doc OMB Attachment 2 Introductory and Follow-up Letters IC Document

Information Collection (IC) Details

IC Title:	Asthma Research Survey	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	1	Asthma Research Survey	OMB Attachment 1 Survey.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,550	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,550	1,550
Annual IC Time Burden (Hours)	388	388
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Attachment 2 Introductory and Follow-up Letters	OMB Attachment 2 Introductory and Follow-up Letters.doc	12/03/2007

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