Information Collection

2011 Follow-Up Questionnaire (TUS-CPS)

IC 191981 under ICR 201102-0925-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
2 TUS-CPS May 2011 Questionnaire Final TUS-CPS May 2011 Follow Up Q _AH fnl OMB_1-27-11[1].doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2011 Follow-Up Questionnaire (TUS-CPS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	1	May 2011 Follow Up Q	ATTACHMENT 2_May 2011 F-UP Q 12-16-09.doc		Yes	Yes	Fillable Fileable
Form and Instruction	2	TUS-CPS May 2011 Questionnaire Final	TUS-CPS May 2011 Follow Up Q _AH fnl OMB_1-27-11[1].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	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
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

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.