Information Collection

Serial Spirometry

IC 185271 under ICR 200806-0920-003 · OMB 0920-0793.

Documents and Forms

Document Name Document Type
Appendix_J.doc Other-WORD
Appendix_E.doc Consent Form IC Document
Appendix_I.doc Notification Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Serial Spirometry	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-WORD			Appendix_J.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	740	740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	Appendix_E.doc	05/29/2008
Notification Letter	Appendix_I.doc	05/29/2008

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