Information Collection

BUILD Student Annual Follow-up Survey 2016 Cohort

IC 221956 under ICR 201703-0925-001 · OMB 0925-0747.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0747 can be found here:

Documents and Forms

Document Name Document Type
Form 5 BUILD Student Annual Follow-up Survey 2016 Cohort Form and Instruction
5 BUILD Student Annual Followup Survey Attachment_12_(Revised 3.10.17) -_BUILD_Student_Annual_Followup_Survey[8].pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BUILD Student Annual Follow-up Survey 2016 Cohort	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	BUILD Student Annual Followup Survey	Attachment_12_(Revised 3.10.17) -_BUILD_Student_Annual_Followup_Survey[8].pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service,	FR Citation: 67 FR 187

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	4,167	4,167
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.