Information Collection

Families

IC 7410 under ICR 201301-0925-002 · OMB 0925-0491.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Families	Form and Instruction
1 Known Informant Letter Attachment 8 -Known number_Death certificate contact notification.doc	Form and Instruction
2 Unknown Informant Letter Attachment 9 -Unknown number Letter.doc	Form and Instruction
3 Informant Interview Form (IFI) Attachment 10 -Informant Interview (IFI) Form.doc	Form and Instruction

IC Title:

Families

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Known Informant Letter	Attachment 8 -Known number_Death certificate contact notification.doc	No	No	Printable Only
Form and Instruction	2	Unknown Informant Letter	Attachment 9 -Unknown number Letter.doc	No	No	Printable Only
Form and Instruction	3	Informant Interview Form (IFI)	Attachment 10 -Informant Interview (IFI) Form.doc	No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	34	34
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.