Information Collection

Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 3

IC 192872 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Document Name Document Type
Form 5 Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 3 Form and Instruction
5 BEEA Home Visit CAPI, Blood, & Urine x 3 Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 19: BEEA Home Visit CAPI, Blood, amp; Urine x 3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	5	BEEA Home Visit CAPI, Blood, & Urine x 3	Attachment 19_CAPI_Questionnaire_Both_Groups - 03-22-10 rev.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: SORN #09-25-0200, Clinical, Epidemiologic, and Biometric Studies of the National Institutes of Health (NIH), HHS/NIH/ OD	FR Citation: 67 FR 60776

Number of Respondents: 20	Number of Respondents for Small Entity: 20

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-60	60
Annual IC Time Burden (Hours)	-30	30
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.