Health Education Materials & Questionnaire - Colonoscopy

Development of a Health Information Rating System (HIRS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0207 can be found here:

Documents and Forms

Document Name Document Type
Form Form #4 Health Education Materials & Questionnaire - Colonoscopy Form and Instruction
Form #4 Health Education Materials & Questionnaire - Colonoscopy Attachment F - Health Education Materials & Questionnaire - Colonoscopy.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Education Materials & Questionnaire - Colonoscopy	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	Form #4	Health Education Materials & Questionnaire - Colonoscopy	Attachment F - Health Education Materials & Questionnaire - Colonoscopy.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	24	24
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.