Information Collection

Participants

IC 7266 under ICR 201403-0925-007 · OMB 0925-0281.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Participants	Form and Instruction
2 Semiannual Follow-up Form Attach 2 Semiannual Followup Form.pdf	Form and Instruction
1 Annual Follow-up Form Attach 1 Annual Followup Form.pdf	Form and Instruction

IC Title:

Participants

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
Form and Instruction	2	Semiannual Follow-up Form	Attach 2 Semiannual Followup Form.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	1	Annual Follow-up Form	Attach 1 Annual Followup Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,049

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	60,294	27,495	32,799
Annual IC Time Burden (Hours)	15,074	-5,147	20,221
Annual IC Cost Burden (Dollars)	0	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.