Information Collection

SEARCH Specimen Collection Form

IC 197884 under ICR 201705-0920-019 · OMB 0920-0904.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SEARCH Specimen Collection Form	Form
Specimen Collection Form Attachment 4A4_Specimen Collection Form r102017.pdf	Form

IC Title:

Agency IC Tracking Number:

0920-0904

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Specimen Collection Form	Attachment 4A4_Specimen Collection Form r102017.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: 823

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	823	113	710
Annual IC Time Burden (Hours)	274	37	237
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.