Information Collection

CDC Water and Health Study (paper questionnaire)

IC 204802 under ICR 201811-0920-007 · OMB 0920-0960.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0960 CDC Water and Health Study (paper questionnaire)	Form
0920-0960 CDC Water and Health Study (paper-based) J.SurveyPaper.pdf	Form

IC Title:

Agency IC Tracking Number:

0920-0960

Is this a Common Form? No

IC Status: Modified

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	0920-0960	CDC Water and Health Study (paper-based)	J.SurveyPaper.pdf		No		Paper Only

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: 240

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	240	-975	1,215
Annual IC Time Burden (Hours)	48	-195	243
Annual IC Cost Burden (Dollars)	0	0	0

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.