Information Collection

SEARCH Initial Participant Survey - Prevalence

IC 227648 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 - Prevalence	Form
Initial Participant Survey - Adult Prevalent Case Attachment 4A5_Initial Participant Survey_Prevalent case_adult r102017.pdf	Form
Initial Participant Survey - Child Prevalent Case Attachment 4A6_Initial Participant Survey_Prevalent case_child r102017.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	n/a	Initial Participant Survey - Adult Prevalent Case	Attachment 4A5_Initial Participant Survey_Prevalent case_adult r102017.pdf		No		Paper Only
Form	n/a	Initial Participant Survey - Child Prevalent Case	Attachment 4A6_Initial Participant Survey_Prevalent case_child r102017.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 776

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	776	776
Annual IC Time Burden (Hours)	129	129
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.