Information Collection

Water Collection

IC 207197 under ICR 201401-0920-004 · OMB 0920-0982.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 10A2_Home Water Sample Collection Instructions for Participants.docx	Instruction
Att 10B_Home Tap Water Collection Procedures for Study Staff.doc Att 10B_Home Tap Water Collection Procedures for Study Staff	IC Document

IC Title:

Water Collection

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Instruction			Att 10A2_Home Water Sample Collection Instructions for Participants.docx		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: 15

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	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 10B_Home Tap Water Collection Procedures for Study Staff	Att 10B_Home Tap Water Collection Procedures for Study Staff.doc	06/04/2013

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