Adult Targeted Surveillance Survey - paper

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

Documents and Forms

Document Name Document Type
Adult Targeted Surveillance Survey - paper Form
Survey Booklet Att 7A_ATSS_PaperBooklet.pdf Form
Survey Booklet - Spanish Att 7A-S_ATSS_PaperBooklet_SP.pdf Form
Att 7B_ATSS_FAQGuide.docx 7b - FAQ Guide IC Document
Att 7B-S_ATSS_FAQGuide_SP.docx 7b(s) - FAQ Guide Spanish IC Document
Att 7D_ATSS_ItemSources_2013_0718.pdf Att 7D_ATSS_ItemSources_2013_0718 IC Document

Information Collection (IC) Details

IC Title:	Adult Targeted Surveillance Survey - paper	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	none	Survey Booklet	Att 7A_ATSS_PaperBooklet.pdf		No	No	Paper Only
Form	none	Survey Booklet - Spanish	Att 7A-S_ATSS_PaperBooklet_SP.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 8,485	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,485	8,485
Annual IC Time Burden (Hours)	4,243	4,243
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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