MUH Operator Baseline Survey - MN, ME, FL

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

Documents and Forms

Document Name Document Type
MUH Operator Baseline Survey - MN, ME, FL Form
MUH Operator Baseline Survey - MN, ME, FL clean 12.17.13 Att 6A(e) Baseline Operator Survey_9.3.13.doc Form
clean 12.17.13 Att 6A-2(e) MUH Operator Survey Consent MN ME FL_9.3.13 c....docx Consent MN, ME, FL IC Document

Information Collection (IC) Details

IC Title:	MUH Operator Baseline Survey - MN, ME, FL	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	MUH Operator Baseline Survey - MN, ME, FL	clean 12.17.13 Att 6A(e) Baseline Operator Survey_9.3.13.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent MN, ME, FL	clean 12.17.13 Att 6A-2(e) MUH Operator Survey Consent MN ME FL_9.3.13 c....docx	12/19/2013

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