End of Year Survey

Backyard Integrated Tick Management Project

Documents and Forms

Document Name Document Type
End of Year Survey Form
Annual End of Year Survey Attachment H_Annual survey.doc Form

Information Collection (IC) Details

IC Title:	End of Year 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	none	Annual End of Year Survey	Attachment H_Annual survey.doc		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	230	230
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	1,373	1,373

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.