State and Local Health Dept Surveillance for Childhood National Blood Lead Surveillance System

National Blood Lead Surveillance

Documents and Forms

Document Name Document Type
Appendix_3.datafields.doc Other-Database submission

Information Collection (IC) Details

IC Title:	State and Local Health Dept Surveillance for Childhood National Blood Lead Surveillance System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Database submission			Appendix_3.datafields.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	168	-168	336
Annual IC Time Burden (Hours)	336	-336	672
Annual IC Cost Burden (Dollars)	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.