Information Collection

Survey of Pet Owners Encountering Ticks (PETS) in Lyme Disease Endemic Areas

IC 228559 under ICR 201606-0920-021 · OMB 0920-1150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1150 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey of Pet Owners Encountering Ticks (PETS) in Lyme Disease Endemic Areas	Form and Instruction
Pet Owners Encountering Ticks (PETs) Survey Attachment 1_PETsSurvey.pdf	Form and Instruction
SS A_GenIC_PetsSurvey_10052017.docx Supporting Statement Part A	IC Document
SS B_GenIC_PetsSurvey_10052017.docx Supporting Statement Part B	IC Document
Attachment 2_Introductory Postcard.pdf Introductory Postcard	IC Document
Attachment 3_Vet Recruitment Letter_v1_080817.docx Veterinary Colleague Recruitment Letter	IC Document
Attachment 4_Thank You Letter_v1_080117.doc Thank You Letter	IC Document
Attachment 5_7049 Exempt Granted Memo_091717.docx IRB Exemption Approval	IC Document
Attachment 6_Withdrawal Letter_v1_080117.doc Withdrawal Letter	IC Document
Attachment 7_Social Media advertisement.pdf Social Media Advertisement	IC Document

IC Title:

Survey of Pet Owners Encountering Ticks (PETS) in Lyme Disease Endemic Areas

Agency IC Tracking Number:

0920-17BCT

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	n/a	Pet Owners Encountering Ticks (PETs) Survey	Attachment 1_PETsSurvey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136

FR Citation: 57 FR 62812

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	5,965	5,965

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	SS A_GenIC_PetsSurvey_10052017.docx	10/05/2017
Supporting Statement Part B	SS B_GenIC_PetsSurvey_10052017.docx	10/05/2017
Introductory Postcard	Attachment 2_Introductory Postcard.pdf	10/05/2017
Veterinary Colleague Recruitment Letter	Attachment 3_Vet Recruitment Letter_v1_080817.docx	10/05/2017
Thank You Letter	Attachment 4_Thank You Letter_v1_080117.doc	10/05/2017
IRB Exemption Approval	Attachment 5_7049 Exempt Granted Memo_091717.docx	10/05/2017
Withdrawal Letter	Attachment 6_Withdrawal Letter_v1_080117.doc	10/05/2017
Social Media Advertisement	Attachment 7_Social Media advertisement.pdf	10/05/2017

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