Sentinel Family Cohort Weekly Illness Report

Information Collection on Cause-Specific Absenteeism in Schools (Pittsburgh Location)

Documents and Forms

Document Name Document Type
Sentinel Family Cohort Weekly Illness Report Form
Cohort Weekly Illness Report Attachment J Cohort Weekly Illness Report_screenshot_yz.docx Form

Information Collection (IC) Details

IC Title:	Sentinel Family Cohort Weekly Illness Report	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 Weekly Illness Report	Attachment J Cohort Weekly Illness Report_screenshot_yz.docx	None	Yes	Yes	Fillable Fileable

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: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,320	4,320
Annual IC Time Burden (Hours)	216	216
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.