Study to Assess Hepatitis Risk: Behavioral Risk Assessment Form

Study To Assess Hepatitis Risk (STAHR)

Documents and Forms

Document Name Document Type
Form 2 Study to Assess Hepatitis Risk: Behavioral Risk Assessment Form Form and Instruction
2 Study to Assess Hepatitis Risk: Behavioral Risk Assessme Attach4.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Study to Assess Hepatitis Risk: Behavioral Risk Assessment Form	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 and Instruction	2	Study to Assess Hepatitis Risk: Behavioral Risk Assessment Form	Attach4.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	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	800	800
Annual IC Time Burden (Hours)	733	733
Annual IC Cost Burden (Dollars)	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.