Information Collection

Primary Data Collection

IC 7528 under ICR 201205-0930-001 · OMB 0930-0119.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0119 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Locator Questionna Primary Data Collection	Form and Instruction
Locator Questionna Locator Questionnaire Attachment A1 - Questionnaire.docx	Form and Instruction
Attachment A3 - CATI Questionnaire.docx CATI Questionnaire	IC Document
Attachment A2 - Web Screens-Questionnaire.docx Web Screens	IC Document
Attachment A4 - Advance Letter.docx Advance Letter	IC Document
Attachment A5 - Cover Letter.docx Advance Letter	IC Document
Attachment A6 - Thank You-Reminder Letter.docx Thank You-Reminder Letter	IC Document
Attachment A7 - Information Site Materials.docx Information Site Materials	IC Document
Attachment A8 - Expert Panel.docx Expert Panel	IC Document

IC Title:

Primary Data Collection

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	Locator Questionnaire	Locator Questionnaire	Attachment A1 - Questionnaire.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,000	2,000	0	13,000
Annual IC Time Burden (Hours)	6,300	0	-6,700	13,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CATI Questionnaire	Attachment A3 - CATI Questionnaire.docx	05/04/2012
Web Screens	Attachment A2 - Web Screens-Questionnaire.docx	05/04/2012
Advance Letter	Attachment A4 - Advance Letter.docx	05/04/2012
Advance Letter	Attachment A5 - Cover Letter.docx	05/04/2012
Thank You-Reminder Letter	Attachment A6 - Thank You-Reminder Letter.docx	05/04/2012
Information Site Materials	Attachment A7 - Information Site Materials.docx	05/04/2012
Expert Panel	Attachment A8 - Expert Panel.docx	05/04/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.