Eligibility Screening Survey - Burmese Immigrants and Descendants

Biomonitoring of Great Lakes Populations Program III

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0056 can be found here:

Documents and Forms

Document Name Document Type
Eligibility Screening Survey - Burmese Immigrants and Descendants Form and Instruction
Eligibility Screening Survey for Burmese Immigrants and 5d.EligibilityScrngSrvy_Burm.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Eligibility Screening Survey - Burmese Immigrants and Descendants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	NA	Eligibility Screening Survey for Burmese Immigrants and their Descendants	5d.EligibilityScrngSrvy_Burm.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

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.