MN Clinic Visit Form

Biomonitoring of Great Lakes Populations Program

OMB: 0923-0044

IC ID: 201464

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

MN Clinic Visit Form
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none MN Clinic Visit Att5f_MN_ClncVstForm_20120131.docx No No Paper Only

Health Immunization Management

 

250 0
   
Individuals or Households
 
   0 %

  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 250 0 0 0 0 250
Annual IC Time Burden (Hours) 4 0 0 0 0 4
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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