Information Collection

Popcorn workers - Questionnaire

IC 207496 under ICR 201306-0920-011 · OMB 0920-0979.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.