Information Collection

CDC INFO - Web survey for email inquirers (English and Spanish)

IC 180271 under ICR 201203-0920-004 · OMB 0920-0753.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0753 CDC INFO - Web survey for email inquirers (English and Spanish)	Form and Instruction
0920-0753 Atachment H Web Survey for Email Inquirers (Spanish) Attachment H Web Survey Email (Spanish).doc	Form and Instruction
0920-0753 Attachment G Web Survey for Email Inquirers (English) Attachment G Web Survey Email (English).doc	Form and Instruction

IC Title:

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	0920-0753	Atachment H Web Survey for Email Inquirers (Spanish)	Attachment H Web Survey Email (Spanish).doc		Yes	Yes	Fillable Printable
Form and Instruction	0920-0753	Attachment G Web Survey for Email Inquirers (English)	Attachment G Web Survey Email (English).doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,460

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,460	1,460
Annual IC Time Burden (Hours)	73	73
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.