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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Surveillance Sampling Outreach Survey

Agency IC Tracking Number:

CFSAN

IC Status: New

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.