Information Collection

Adult Targeted Surveillance Survey - paper

IC 203625 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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.