Information Collection

Health Status Evaluation of an Infantry Battalion Following Deployment iso Operation Iraqi Freedom (2004-2005)

IC 231467 under ICR 201805-0702-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Informed Consent.docx	Other-Consent Form
Survey.docx	Other-Survey

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			Survey.docx		Yes	Yes	Fillable Fileable Signable
Other-Consent Form			Informed Consent.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	3,500	3,500
Annual IC Cost Burden (Dollars)	83,510	83,510

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.