Eligibility Screening Survey - Burmese Immigrants and Descendants

Biomonitoring of Great Lakes Populations Program III

Documents and Forms

Document Name Document Type
Form 0923-0056 Eligibility Screening Survey - Burmese Immigrants and Descendants Form and Instruction
0923-0056 Eligibility Screening Survey for Burmese Immigrants and 5d.Eligibility_ScrngSrvy_Burm_20180111_clean.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: Modified

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	0923-0056	Eligibility Screening Survey for Burmese Immigrants and their Descendants - 16JAN2018	5d.Eligibility_ScrngSrvy_Burm_20180111_clean.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.