Information Collection

HBV and HCV Risk Factor

IC 187041 under ICR 201411-0925-001 · OMB 0925-0596.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1.2 HBV and HCV Risk Factor	Form and Instruction
1.2 HBV HCV Attachment 1.2_HBV&HCV Qx.doc	Form and Instruction
Attachment 2.3_Consent HBV.doc Attachment 2	IC Document

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	1.2	HBV HCV	Attachment 1.2_HBV&HCV Qx.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,870

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,870	2,870
Annual IC Time Burden (Hours)	-947	947
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2	Attachment 2.3_Consent HBV.doc	10/22/2008

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