Information Collection

Participant Instruction and Record Book

IC 220642 under ICR 201508-0920-005 · OMB 0920-1107.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Participant Instruction and Record Book	Form and Instruction
Participant Instruction Record Book AppndxD1 Participant Instruction Record Book.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Participant Instruction Record Book	AppndxD1 Participant Instruction Record Book.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and surveillance of disease problems

FR Citation: 57 FR 62812

Number of Respondents: 22

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	88	88
Annual IC Time Burden (Hours)	44	44
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.