Information Collection

Laboratory visit

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.