Information Collection

Low-Intensity Questionnaire (Non- and Pregnant) (TT-LI)

IC 193562 under ICR 201109-0925-003 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 12.1 Low-Intensity Questionnaire (Non- and Pregnant) (TT-LI)	Form and Instruction
12.1 Survey Low-Intensity Questionnaire (Non- & Pregnant) 20110211.docx	Form and Instruction

IC Title:

Low-Intensity Questionnaire (Non- and Pregnant) (TT-LI)

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 and Instruction	12.1	Survey	Low-Intensity Questionnaire (Non- & Pregnant) 20110211.docx		Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,575

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	10,575	10,575
Annual IC Time Burden (Hours)	5,288	5,288
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.