Information Collection

2011 Follow-Up Questionnaire (TUS-CPS)

IC 191981 under ICR 201404-0925-002 · OMB 0925-0368.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2011 Follow-Up Questionnaire (TUS-CPS)	Form and Instruction
1 May 2011 Follow Up Q ATTACHMENT 2_May 2011 F-UP Q 12-16-09.doc	Form and Instruction
2 TUS-CPS May 2011 Questionnaire Final TUS-CPS May 2011 Follow Up Q _AH fnl OMB_1-27-11[1].doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	May 2011 Follow Up Q	ATTACHMENT 2_May 2011 F-UP Q 12-16-09.doc		Yes	Yes	Fillable Fileable
Form and Instruction	2	TUS-CPS May 2011 Questionnaire Final	TUS-CPS May 2011 Follow Up Q _AH fnl OMB_1-27-11[1].doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	0	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
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.