Physician (for heart failure)

The Atherosclerosis Risk in Communities Study (ARIC)

Documents and Forms

Document Name Document Type
Form 1 Physician (for heart failure) Form and Instruction
1 Heart Failure Attach 5 Heart Failure Survey.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Physician (for heart failure)	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 and Instruction	1	Heart Failure	Attach 5 Heart Failure Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,200	280	920
Annual IC Time Burden (Hours)	200	123	77
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.