Information Collection

Data Collection Packet

IC 227865 under ICR 201708-0920-011 · OMB 0920-1219.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 6. Cover Sheet for Data Collection Packet.doc	Instruction
Attachment 6.a.1 - SEED Teen letter to accompany data collection and consent forms packet_v1.docx	Instruction
Attachment 6.a.2 -SEED Teen letter to accompany data collection and consent forms packet_v2.docx	Instruction
Attachment 6.b.1 - SEED Teen Participant Information Sheet_v1.doc	Instruction
Attachment 6.b.2 - SEED Teen Participant Information Sheet_v2.doc	Instruction

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	Available Electronically?	Electronic Capability
Instruction	No	Paper Only
Instruction	No	Paper Only
Instruction	No	Paper Only
Instruction	No	Paper Only
Instruction	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveilance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 158

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	158	158
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	229	229

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.

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