OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Reporting: Survey

IC 199201 under ICR 201206-0910-013 · OMB 0910-0706.

Documents and Forms
Document Name
Document Type
Other-Survey Questionnaire
Other-english screen shots
Other-spanish screen shots
Information Collection (IC) Details

View Information Collection (IC)

Reporting: Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Questionnaire Appendix A Hispanic study draft questionnaire 0611.doc Yes Yes Fillable Printable
Other-english screen shots 0910-0706 final instrument English.pdf Yes No Printable Only
Other-spanish screen shots 0910-0706 final instrument Spanish.pdf Yes No Printable Only

Health Consumer Health and Safety

 

2,400 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 600 0 0 0 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.