Questionnaire A - F

NAHMS Emergency Epidemiologic Investigations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0376 can be found here:

Documents and Forms

Document Name Document Type
Form Questionnaire A - Questionnaire A - F Form and Instruction
Questionnaire A - Premises Level Questionnaire Questionnaire A-F.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Questionnaire A - F	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 and Instruction	Questionnaire A - F	Premises Level Questionnaire	Questionnaire A-F.pdf		No		Paper Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,100	Number of Respondents for Small Entity: 105

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,100	2,100
Annual IC Time Burden (Hours)	2,100	2,100
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.