Katrina and Rita Exposures Registry - questionnaire

Registration of Individuals Displaced by Hurricanes Katrina and Rita (Pilot Project)

OMB: 0923-0045

IC ID: 201175

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Katrina and Rita Exposures Registry - questionnaire
 
No Modified
 
Voluntary
 

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

Health Immunization Management

Records of Persons Exposed to or Potentially Exposed to Toxic or Hazardous Substances  53 FR 30720

1,500 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 1,500 0 1,500 0 0 0
Annual IC Time Burden (Hours) 450 0 450 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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