Information Collection

HBV and HCV Risk Factor

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HBV and HCV Risk Factor	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 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 %

	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

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.