Information Collection

Adult Targeted Surveillance Survey - screener

IC 203638 under ICR 201305-0920-002 · OMB 0920-0977.

Documents and Forms

Document Name Document Type
Adult Targeted Surveillance Survey - screener Form
Adult Targeted Surveillance Survey - telephone screener Att 7C_ATSS_PhoneInterview.docx Form
Adult Targeted Surveillance Survey telephone screener- S Att 7C-S_ATSS_PhoneInterview_SP.docx Form
Att 7D_ATSS_ItemSources_2013_0718.pdf Att 7D_ATSS_ItemSources_2013_0718 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Adult Targeted Surveillance Survey - screener	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	Adult Targeted Surveillance Survey - telephone screener	Att 7C_ATSS_PhoneInterview.docx		Yes	Yes	Fillable Fileable
Form	none	Adult Targeted Surveillance Survey telephone screener- Spanish	Att 7C-S_ATSS_PhoneInterview_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: 13,749	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,749	13,749
Annual IC Time Burden (Hours)	458	458
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 7D_ATSS_ItemSources_2013_0718	Att 7D_ATSS_ItemSources_2013_0718.pdf	08/06/2013

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