Information Collection

Illness Perception Questionnaire

IC 183875 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 Illness Perception Questionnaire	Form
No number Illness Perception Questionnaire Attachment 24 Illness Perception Questionnaire.pdf	Form
Attachment 24 Illness Perception Questionnaire OMB Cover sheet.doc Illness Perception 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	Illness Perception Questionnaire	Attachment 24 Illness Perception 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: 246

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	246	246
Annual IC Time Burden (Hours)	82	82
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Illness Perception Questionnaire - Coverpage	Attachment 24 Illness Perception Questionnaire OMB Cover sheet.doc	12/19/2007

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