Information Collection

SEARCH - Initial Participant Survey - Incident

IC 197864 under ICR 201705-0920-019 · OMB 0920-0904.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SEARCH - Initial Participant Survey - Incident	Form
Initial Participant Survey - Incident Case Child Version Attachment 4A2a Initial participant survey child screen shot r102017.pdf	Form
Initial Participant Survey - Incident Case Child Version Attachment 4A2a_Initial Participant Survey_incident case_child r102017.pdf	Form
Initial Participant Survey - Incident Case Young Adult V Attachment 4A2b Initial participant survey adult screen shot r102017.pdf	Form
Initial Participant Survey - Incident Case Young Adult v Attachment 4A2b_Initial Participant Survey_incident case_ Adult r 102017....pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Initial Participant Survey - Incident Case Child Version (screen shots)	Attachment 4A2a Initial participant survey child screen shot r102017.pdf	Yes	Yes	Fillable Fileable
Form	n/a	Initial Participant Survey - Incident Case Child Version (Paper)	Attachment 4A2a_Initial Participant Survey_incident case_child r102017.pdf	No		Paper Only
Form	n/a	Initial Participant Survey - Incident Case Young Adult Version (screen shots)	Attachment 4A2b Initial participant survey adult screen shot r102017.pdf	Yes	Yes	Fillable Fileable
Form	n/a	Initial Participant Survey - Incident Case Young Adult version (paper)	Attachment 4A2b_Initial Participant Survey_incident case_ Adult r 102017....pdf	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 1,511

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	Previously Approved
Annual Number of Responses for this IC	1,511	236	1,275
Annual IC Time Burden (Hours)	252	39	213
Annual IC Cost Burden (Dollars)	0	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.