Information Collection

Health Survey of former Marines, dependents, and employees at USMC Base Camp LeJeune and USMC Base Camp Pendleton

IC 191365 under ICR 200911-0923-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Health Survey of former Marines, dependents, and employees at USMC Base Camp LeJeune and USMC Base Camp Pendleton	Form
Health Survey Attach C survey Qs.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Health Survey	Attach C survey Qs.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Records or Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances

FR Citation: 57 FR 62812

Number of Respondents: 73,739

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 33 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	73,739	73,739
Annual IC Time Burden (Hours)	55,304	55,304
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.