Gulf States Population Survey

Division of Behavioral Surveillance (DBS) Gulf States Population Survey

Documents and Forms

Document Name Document Type
Gulf States Population Survey Form
Gulf States Population Survey GSPS Questions ICR 3-02-2011 .docx Form

Information Collection (IC) Details

IC Title:	Gulf States Population Survey	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	none	Gulf States Population Survey	GSPS Questions ICR 3-02-2011 .docx		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	20,000	20,000
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.