Information Collection

Biological Sample Collection Questionnaire (Randomly Selected)

IC 191959 under ICR 201002-0925-001 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Biological Sample Collection Questionnaire (Randomly Selected)	Form
1 Biological Sample Collection Questionnaire (Randomly Sel AHS Biomarker Study Questionnaire - 01-07-10.doc	Form

IC Title:

Biological Sample Collection Questionnaire (Randomly Selected)

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	1	Biological Sample Collection Questionnaire (Randomly Selected)	AHS Biomarker Study Questionnaire - 01-07-10.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,550

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,550	1,550
Annual IC Time Burden (Hours)	2,325	2,325
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.