Information Collection

Objectives 1 and 2 Risk Factor Assessment

IC 218306 under ICR 201509-0925-003 · OMB 0925-0736.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Objectives 1 and 2 Risk Factor Assessment	Form and Instruction
3 Brazil SCD Rick Factor Assessment Attachment_1_Brazil_SCD_Risk_Factor_Assessment_3_2016_V_7.0.docx	Form and Instruction
Attachment_5_Risk_Factor_Assessment_Portuguese_7_21_2015_V_3.0.docx Attachment 5 Risk Factor Assessment Portuguese	IC Document

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	3	Brazil SCD Rick Factor Assessment	Attachment_1_Brazil_SCD_Risk_Factor_Assessment_3_2016_V_7.0.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 325

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	325	325
Annual IC Time Burden (Hours)	244	244
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5 Risk Factor Assessment Portuguese	Attachment_5_Risk_Factor_Assessment_Portuguese_7_21_2015_V_3.0.docx	09/22/2015

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