Information Collection

Study Salt Supplement Questionnaire

IC 207200 under ICR 201306-0920-001 · OMB 0920-0982.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0982 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Study Salt Supplement Questionnaire Study Salt Supplement Questionnaire	Form
Study Salt Supplement Questionnaire Att 17A_Study Salt Supplement Questionnaire.docx	Form
Att 17B_Study Salt Supplement Intructions for Participants.docx Att 17B_Study Salt Supplement Intructions for Participants	IC Document
Att 17D_Study Salt Supplement Procedures for Study Staff.doc Att 17D_Study Salt Supplement Procedures for Study Staff	IC Document
Att 17C_Study Salt Supplement Record (to be completed by clinic staff).doc Att 17C_Study Salt Supplement Record (to be completed by clinic staff)	IC Document

IC Title:

Study Salt Supplement Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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				Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 75

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	225	225
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 17B_Study Salt Supplement Intructions for Participants		06/04/2013
Att 17D_Study Salt Supplement Procedures for Study Staff		06/04/2013
Att 17C_Study Salt Supplement Record (to be completed by clinic staff)		06/04/2013

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

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