Information Collection

Health and Genetics from YOUR Point of View

IC 209618 under ICR 201403-0925-011 · OMB 0925-0700.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health and Genetics from YOUR Point of View	Form and Instruction
1 Screenshot: Health and Genetics from YOUR Point of View Attach 9. Screenshot Health and Genetics from YOUR Point of View-Klein.pdf	Form and Instruction
Attach 8. Survey Health and Genetics from YOUR Point of View-Klein.pdf Attach 8	IC Document

IC Title:

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	1	Screenshot: Health and Genetics from YOUR Point of View	Attach 9. Screenshot Health and Genetics from YOUR Point of View-Klein.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	12,500	12,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 8	Attach 8. Survey Health and Genetics from YOUR Point of View-Klein.pdf	03/24/2014

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