Information Collection

Non-Respondent Survey Questionnaire

IC 213408 under ICR 201502-0920-014 · OMB 0920-1047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Non-Respondent Survey Questionnaire	Form and Instruction
Non-Respondent Survey Questionnaire AppendixE_change request.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

15QF

Is this a Common Form? No

IC Status: Modified

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	None	Non-Respondent Survey Questionnaire	AppendixE_change request.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: 09-20-0147, Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.