Information Collection

Eligibility Screening Survey, Bhutanese and Burmese

IC 213772 under ICR 201506-0923-001 · OMB 0923-0052.

Documents and Forms

Document Name Document Type
Eligibility Screening Survey, Bhutanese and Burmese Form and Instruction
Screening Survey Bhutan Burm Att8a_ScreeningSurveyBhutan_Burm.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Eligibility Screening Survey, Bhutanese and Burmese	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	none	Screening Survey Bhutan Burm	Att8a_ScreeningSurveyBhutan_Burm.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	21	21
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.