Information Collection

Biomonitoring Interview Questionnaire, Bhutanese and Burmese

IC 213775 under ICR 201506-0923-001 · OMB 0923-0052.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Biom Questionnaire Bhutan Burm Biomonitoring Interview Questionnaire, Bhutanese and Burmese	Form and Instruction
Biom Questionnaire Bhutan Burm Att8c_BiomQuestionnaire_Bhutan_Burm.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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				No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	113	113
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.

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