Information Collection

Generation 3 and Omni Group 2 Cohorts

IC 208860 under ICR 201604-0925-002 · OMB 0925-0216.

Documents and Forms

Document Name Document Type
Form A4 Generation 3 and Omni Group 2 Cohorts Form and Instruction
A4 Health Status Update Form Attachment 4 - Medical Hx Update Form.pdf Form and Instruction
6a Records Request Form Attachment 6a- Records Request.pdf Form and Instruction
6b Informant Contact Form Attachment 6b- Informant Contact.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Generation 3 and Omni Group 2 Cohorts	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	A4	Health Status Update Form	Attachment 4 - Medical Hx Update Form.pdf	Yes	Yes	Paper Only
Form and Instruction	6a	Records Request Form	Attachment 6a- Records Request.pdf	Yes	Yes	Paper Only
Form and Instruction	6b	Informant Contact Form	Attachment 6b- Informant Contact.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,432	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4,432	4,432
Annual IC Time Burden (Hours)	-1,898	1,898
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.