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Health questionnaire
Aerosol Generation by Cough
OMB: 0920-0784
IC ID: 183661
OMB.report
HHS/CDC
OMB 0920-0784
ICR 200802-0920-002
IC 183661
( )
Documents and Forms
Document Name
Document Type
Attachment 5 Health questionnaire.doc
Other-health questionnaire
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health questionnaire
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
Other-health questionnaire
Attachment 5 Health questionnaire.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
0920-0147: Occupational Health Epidemiological Studies and EEOICPA Program Records
FR Citation:
51 FR 42449
Number of Respondents:
140
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
140
0
140
0
0
0
Annual IC Time Burden (Hours)
12
0
12
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
