Adult Proxy Survey - Adults 18 or older

Traumatic Brain Injury (TBI) Surveillance System

OMB: 0920-1240

IC ID: 232647

Information Collection (IC) Details

View Information Collection (IC)

Adult Proxy Survey - Adults 18 or older
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Adult Proxy Survey - English E-3 Adult-Proxy Survey -- English.docx NA Yes Yes Fillable Fileable
Form and Instruction NA Adult Proxy Survey - Spanish E-9 Adult-Proxy Survey -- Spanish.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

750 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 750 0 750 0 0 0
Annual IC Time Burden (Hours) 288 0 288 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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