CDC Water and Health Study (Web-Based Questionnaire)

Epidemiologic Study of Health Effects Associated with Low Pressure Events in Drinking Water Distribution Systems

Documents and Forms

Document Name Document Type
Form 0920-0960 CDC Water and Health Study (Web-Based Questionnaire) Form
0920-0960 CDC Water and Health Study (web-based) I. Survey Web Screen Shots.pdf Form

Information Collection (IC) Details

IC Title:	CDC Water and Health Study (Web-Based Questionnaire)	Agency IC Tracking Number:	0920-0960

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	0920-0960	CDC Water and Health Study (web-based)	I. Survey Web Screen Shots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62821

Number of Respondents: 160	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	160	-650	810
Annual IC Time Burden (Hours)	32	-130	162
Annual IC Cost Burden (Dollars)	0	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.