Information Collection

Laboratory visit

IC 194764 under ICR 201009-0920-006 · OMB 0920-0736.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Laboratory visit	Form
No number Laboratory visit Attachment G-1. Lab Visit Forms.pdf	Form
Attachment G-2. Lab Visit Instructions.docx Lab visit instructions	IC Document

IC Title:

Laboratory visit

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	No number	Laboratory visit	Attachment G-1. Lab Visit Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	122	122
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Lab visit instructions	Attachment G-2. Lab Visit Instructions.docx	08/23/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.