Information Collection

Participants

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.