Information Collection

Social Support Questionnaire

IC 183880 under ICR 200802-0920-009 · OMB 0920-0788.

Documents and Forms

Document Name Document Type
Form No number Social Support Questionnaire Form
No number Social Support Questionnaire Attachment 24 Social Support Questionnaire.pdf Form
Attachment 24 Social Support Questionnaire OMB Cover page.doc Social Support Questionnaire - Coverpage IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Social Support 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
Form	No number	Social Support Questionnaire	Attachment 24 Social Support 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 %

	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

Title	Document	Date Uploaded
Social Support Questionnaire - Coverpage	Attachment 24 Social Support 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.