Information Collection

Sentinel Family Cohort Intake Form

IC 214476 under ICR 201412-0920-016 · OMB 0920-1056.

Documents and Forms

Document Name Document Type
Sentinel Family Cohort Intake Form Form
Cohort Intake Form Attachment I Cohort intake form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Sentinel Family Cohort Intake Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Cohort Intake Form	Attachment I Cohort intake form.pdf	None	No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160, Records of Subjects in Health Promotion and Eductaion Studie	FR Citation: 51 FR 42484

Number of Respondents: 360	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	60	60
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.