Information Collection

Monthly Survey

IC 227801 under ICR 201708-0920-006 · OMB 0920-1203.

Documents and Forms

Document Name Document Type
Form noen Monthly Survey Form
noen Monthly Tick Encounter Survey Attachment F_Monthly Survey.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Monthly Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	noen	Monthly Tick Encounter Survey	Attachment F_Monthly Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 230	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	920	920
Annual IC Time Burden (Hours)	153	153
Annual IC Cost Burden (Dollars)	14,637	14,637

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.