Questionnaire A - F

NAHMS Emergency Epidemiologic Investigations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0376 can be found here:

Documents and Forms

Document Name Document Type
Form Questionnaire A - Questionnaire A - F Form and Instruction
Questionnaire A - Premises Level Questionnaire Questionnaire A-F New.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Questionnaire A - F	Agency IC Tracking Number:

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 and Instruction	Questionnaire A - F	Premises Level Questionnaire	Questionnaire A-F New.pdf		No		Paper Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,802	Number of Respondents for Small Entity: 140

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,802	702	2,100
Annual IC Time Burden (Hours)	2,802	702	2,100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.