Information Collection

Surveillance Sampling Outreach Survey

IC 221354 under ICR 201404-0910-010 · OMB 0910-0500.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0500 can be found here:

Documents and Forms

Document Name Document Type
Appendix A 0500 Surveillance Sampling Outreach Questions 5-2-2016.doc Other-Survey
Appendix B 0500 Potential Respondents 5-2-2016.doc Other-List of Stakeholders
OMB Justification Memo for Surveillance Sampling Outreach.doc OMB Justification Memo for Gen IC Request for Rapid Response IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Surveillance Sampling Outreach Survey	Agency IC Tracking Number:	CFSAN

IC Status: New

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
Other-Survey			Appendix A 0500 Surveillance Sampling Outreach Questions 5-2-2016.doc		Yes	Yes	Paper Only
Other-List of Stakeholders			Appendix B 0500 Potential Respondents 5-2-2016.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	275	275
Annual IC Time Burden (Hours)	550	550
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo for Gen IC Request for Rapid Response	OMB Justification Memo for Surveillance Sampling Outreach.doc	05/03/2016

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