Information Collection

Questionnaires

IC 200469 under ICR 201307-0910-005 · OMB 0910-0707.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX B - Phase 1 and 2 - Comparative Study Questionnaire.doc	Other-Questionnaire

IC Title:

Questionnaires

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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-Questionnaire			APPENDIX B - Phase 1 and 2 - Comparative Study Questionnaire.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,060

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	Previously Approved
Annual Number of Responses for this IC	7,060	7,060
Annual IC Time Burden (Hours)	2,353	2,353
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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