Popcorn workers - Questionnaire

Spectrum of Flavoring Chemical-Related Lung Disease

Documents and Forms

Document Name Document Type
Appx D1_Pop_Questionnaire.ENG.docx Other-WORD
Appx D2_Pop_Questionnnaire.SPAN.docx Other-WORD
Appx L1_PhoneScript_Popcorn-ENG.docx Appx L1_PhoneScript_Popcorn-ENG IC Document
Appx L2_PhoneScript_Popcorn-SPAN.docx Appx L2_PhoneScript_Popcorn-SPAN IC Document

Information Collection (IC) Details

IC Title:	Popcorn workers - Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-WORD			Appx D1_Pop_Questionnaire.ENG.docx		Yes	Yes	Fillable Printable
Other-WORD			Appx D2_Pop_Questionnnaire.SPAN.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0147 Occupatinal Health Epidemiological Studies	FR Citation: 51 FR 42449

Number of Respondents: 81	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	81	81
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appx L1_PhoneScript_Popcorn-ENG	Appx L1_PhoneScript_Popcorn-ENG.docx	06/24/2013
Appx L2_PhoneScript_Popcorn-SPAN	Appx L2_PhoneScript_Popcorn-SPAN.docx	06/24/2013

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