Information Collection

Web-based Survey: Livestock Abortion-Associated Zoonoses

IC 234166 under ICR 201810-0920-005 · OMB 0920-1251.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Web-based Survey: Livestock Abortion-Associated Zoonoses	Form and Instruction
Survey - Livestock Abortion-Associated Zoonoses Web survey online format_12312018.docx	Form and 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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Survey - Livestock Abortion-Associated Zoonoses	Web survey online format_12312018.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	5,335	5,335

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.