Information Collection

Core Questionnaire

IC 186174 under ICR 200808-0920-006 · OMB 0920-0794.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0794 can be found here:

Documents and Forms

Document Name Document Type
092007BK Att 3B -- THBS Core Questionnaire June 2008.doc Other-Core questionnaire

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Core 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
Other-Core questionnaire			092007BK Att 3B -- THBS Core Questionnaire June 2008.doc		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
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.