Information Collection

World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey (Spanish and Polish versions)

IC 208833 under ICR 201211-0920-003 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey (Spanish and Polish versions)	Form and Instruction
Members in the WTCHP General Responders Consortium--Span WTCHP GRC Outreach Survey Spanish.docx	Form and Instruction
Members in the WTCHP General Responders Consortium Polis WTCHP GRC Outreach Survey Polish.docx	Form and Instruction
OMB fast track form - WTCHP Spanish and Polish.doc OMB fast track form - WTCHP Spanish and Polish	IC Document

IC Title:

World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey (Spanish and Polish versions)

Agency IC Tracking Number:

IC Status: New

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	None	Members in the WTCHP General Responders Consortium--Spanish Version	WTCHP GRC Outreach Survey Spanish.docx		Yes	No	Paper Only
Form and Instruction	None	Members in the WTCHP General Responders Consortium Polish Version	WTCHP GRC Outreach Survey Polish.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	1	0	0	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB fast track form - WTCHP Spanish and Polish	OMB fast track form - WTCHP Spanish and Polish.doc	09/26/2013

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