Information Collection

Moderator's Guide

IC 192851 under ICR 201102-0920-004 · OMB 0920-0858.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Moderator's Guide	Form
Moderator's Guide for Parents - phone ModeratorguideparentsphoneREV_010511.doc	Form
Moderator's Guide for Young Adults - phone ModeratorguideyoungadultsphoneREV_010510.doc	Form

IC Title:

Moderator's Guide

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Moderator's Guide for Parents - phone	ModeratorguideparentsphoneREV_010511.doc		No	No	Paper Only
Form	none	Moderator's Guide for Young Adults - phone	ModeratorguideyoungadultsphoneREV_010510.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 108

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	Previously Approved
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	162	162
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.