Information Collection

BEEA AMG Home Visit CAPI, Blood, Urine, Buccal cell & Dust

IC 220914 under ICR 201604-0925-001 · OMB 0925-0406.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13 BEEA AMG Home Visit CAPI, Blood, Urine, Buccal cell & Dust	Form and Instruction
13 Attachment 19-1 BEEA CAPI Questionnaire Attachment 19-1_BEEA CAPI Questionnaire_v2.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	13	Attachment 19-1 BEEA CAPI Questionnaire	Attachment 19-1_BEEA CAPI Questionnaire_v2.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0200 Clinical, Basic and Population-based Research Studies

FR Citation: 67 FR 60776

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

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	32	32
Annual IC Time Burden (Hours)	48	48
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.