Information Collection

Pre and Post Shift Red Tide Questionnaire

IC 188448 under ICR 200903-0920-007 · OMB 0920-0494.

Documents and Forms

Document Name Document Type
Att.4_Pre_Post Shift Red Tide Questionnaire_020609.doc.rtf Other-Word

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre and Post Shift Red Tide Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.9 5 CFR 1328.8(b)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Word			Att.4_Pre_Post Shift Red Tide Questionnaire_020609.doc.rtf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
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.