Athlete weekly surveillance report

Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1073 can be found here:

Documents and Forms

Document Name Document Type
Athlete weekly surveillance report Form
Athlete weekly surveillance report AttachF-Weekly Ath IVR_rev0323.doc Form
AttachR_Weekly Report Follow Up email phone script.docx Weekly report follow-up IC Document

Information Collection (IC) Details

IC Title:	Athlete weekly surveillance 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	Athlete weekly surveillance report	AttachF-Weekly Ath IVR_rev0323.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Records of subjects in health promotion and educational studies	FR Citation: 51 FR 42484

Number of Respondents: 1,518	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,180	15,180
Annual IC Time Burden (Hours)	759	759
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Weekly report follow-up	AttachR_Weekly Report Follow Up email phone script.docx	03/30/2015

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