Information Collection

Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 3

IC 192872 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 5 Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 3 Form and Instruction
5 BEEA Home Visit CAPI, Blood, & Urine x 3 Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 19: BEEA Home Visit CAPI, Blood, & Urine x 3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5	BEEA Home Visit CAPI, Blood, & Urine x 3	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: 20	Number of Respondents for Small Entity: 20

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	60	30	30
Annual IC Time Burden (Hours)	30	20	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.