Information Collection

Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS

IC 192870 under ICR 201302-0925-004 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS	Form and Instruction
3 BEEA Home Visit CAPI, Blood, & Urine x 1 Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc	Form and Instruction

IC Title:

Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 1 for AHS

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	3	BEEA Home Visit CAPI, Blood, & Urine x 1	Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD

FR Citation: 67 FR 60776

Number of Respondents: 160

Number of Respondents for Small Entity: 160

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	-150	310
Annual IC Time Burden (Hours)	80	-23	103
Annual IC Cost Burden (Dollars)	0	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.