Information Collection

2011 Follow-Up Questionnaire (TUS-CPS)

IC 191981 under ICR 201002-0925-002 · OMB 0925-0368.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0368 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2011 Follow-Up Questionnaire (TUS-CPS)	Form and Instruction
1 May 2011 Follow Up Q ATTACHMENT 2_May 2011 F-UP Q 12-16-09.doc	Form and Instruction

IC Title:

2011 Follow-Up Questionnaire (TUS-CPS)

Agency IC Tracking Number:

Is this a Common Form?

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 and Instruction	1	May 2011 Follow Up Q	ATTACHMENT 2_May 2011 F-UP Q 12-16-09.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	1,500	1,500
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.