Information Collection

Traumatic Life Events Questionnaire

IC 183867 under ICR 200802-0920-009 · OMB 0920-0788.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Traumatic Life Events Questionnaire	Form
No number Traumatic Life Events Questionnaire Attachment 25 Trauumatic Life Events Questionnaire.pdf	Form
Attachment 25 Traumatic Life Events Questionnaire OMB Cover Page.doc Traumatic Life Events Questionnaire - Coverpage	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
Form	No number	Traumatic Life Events Questionnaire	Attachment 25 Trauumatic Life Events Questionnaire.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 196

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
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Traumatic Life Events Questionnaire - Coverpage	Attachment 25 Traumatic Life Events Questionnaire OMB Cover Page.doc	12/19/2007

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