Information Collection

Adult Biometric Measures

IC 203629 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Adult Biometric Measures	Form
Adult Biometric Measures Att 12A_AdultBioMeasures.docx	Form
Adult Biometric Measures - Spanish Att 12A-S_AdultBioMeasures_SP.docx	Form
Att 12C_AdultBioMeasures_ItemSources_2013_0618.pdf Att 12C_AdultBioMeasures_ItemSources_2013_0618	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	Adult Biometric Measures	Att 12A_AdultBioMeasures.docx		Yes	Yes	Fillable Fileable
Form	none	Adult Biometric Measures - Spanish	Att 12A-S_AdultBioMeasures_SP.docx		Yes	Yes	Fillable Fileable

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: 2,667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,667	2,667
Annual IC Time Burden (Hours)	1,334	1,334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 12C_AdultBioMeasures_ItemSources_2013_0618	Att 12C_AdultBioMeasures_ItemSources_2013_0618.pdf	08/06/2013

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