Information Collection

Exploring Our Identity Genetics Ancestry and Race

IC 209623 under ICR 201403-0925-011 · OMB 0925-0700.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Exploring Our Identity Genetics Ancestry and Race	Form and Instruction
1 Screenshot: Exploring Our Identity: Genetics, Ancestry, Attach 19. Screenshot Exploring Our Identity Genetics, Ancestry, and Race-Bonham.pdf	Form and Instruction
Attach 18. Survey Exploring Our Identity Genetics, Ancestry, and Race-Bonham.pdf Attach 18	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: Exploring Our Identity: Genetics, Ancestry, and Race	Attach 19. Screenshot Exploring Our Identity Genetics, Ancestry, and Race-Bonham.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)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach 18	Attach 18. Survey Exploring Our Identity Genetics, Ancestry, and Race-Bonham.pdf	03/24/2014

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