Information Collection

Katrina and Rita Exposures Registry - questionnaire

IC 201175 under ICR 201211-0923-001 · OMB 0923-0045.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Katrina and Rita Exposures Registry - questionnaire	Form and Instruction
Quesitonaire Appendix F Main Questionnaire 20130130.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	none	Quesitonaire	Appendix F Main Questionnaire 20130130.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Records of Persons Exposed to or Potentially Exposed to Toxic or Hazardous Substances

FR Citation: 53 FR 30720

Number of Respondents: 1,500

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	450	450
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.