Information Collection

Tainted Beverage_Mozambique

IC 214724 under ICR 201504-0920-005 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1. Questionnaire - English.docx	Other-WORD
Appendix 2. Questionnaire - Portuguese.docx	Other-WORD
Letter of Invitation.PDF Letter of Invitation	IC Document
2015005-XXX_Tainted Beverage_Mozambique.docx Request for Approval	IC Document
URGENT 0920-1011 GenIC Request 2015005-XXX Tainted Beverage_Mozambique.msg Email with Burden	IC Document

IC Title:

Tainted Beverage_Mozambique

Agency IC Tracking Number:

15ME

IC Status: Unchanged

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
Other-WORD			Appendix 1. Questionnaire - English.docx		No		Paper Only
Other-WORD			Appendix 2. Questionnaire - Portuguese.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter of Invitation	Letter of Invitation.PDF	01/22/2015
Request for Approval	2015005-XXX_Tainted Beverage_Mozambique.docx	01/22/2015
Email with Burden	URGENT 0920-1011 GenIC Request 2015005-XXX Tainted Beverage_Mozambique.msg	01/22/2015

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