Information Collection

NY Screener - Burmese

IC 201472 under ICR 201407-0923-001 · OMB 0923-0044.

Documents and Forms

Document Name Document Type
NY Screener - Burmese Form
NY Screener - Burmese Att6h_NY_ScrnSrvy_Brms_20120619.docx Form
Screener - Burmese translation Att6h_NY_ScrnSrvy_Brms_20120619 (Burmese Translation).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NY Screener - Burmese	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form	none	NY Screener - Burmese	Att6h_NY_ScrnSrvy_Brms_20120619.docx		No	No	Paper Only
Form	none	Screener - Burmese translation	Att6h_NY_ScrnSrvy_Brms_20120619 (Burmese Translation).pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 184	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	184	184
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.