Information Collection

Contact information - Spanish

IC 220012 under ICR 201607-0920-007 · OMB 0920-1122.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1122 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Contact information - Spanish	Form
Contact information - Spanish Att. 18 - Spanish Contact Info.pdf	Form

IC Title:

Contact information - Spanish

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	none	Contact information - Spanish	Att. 18 - Spanish Contact Info.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiological Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 133

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	133	133
Annual IC Time Burden (Hours)	4	4
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.