Information Collection

Knowledge, Attitudes, and Practices Individual Questionnaire

IC 234595 under ICR 201812-0920-004 · OMB 0920-1254.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1254 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-18ANU Knowledge, Attitudes, and Practices Individual Questionnaire	Form and Instruction
0920-18ANU KAP Adult 6. EN Paper Questionnaire - KAP Adult.docx	Form and Instruction
0920-18ANU KAP Older Child 6. EN Paper Questionnaire - KAP Older Child.docx	Form and Instruction
0920-18ANU KAP Younger Child 6. EN Paper Questionnaire - KAP Younger Child.docx	Form and Instruction
0920-18ANU Spanish KAP Adult 6. ES Paper Questionnaire - KAP Adult.docx	Form and Instruction
0920-18ANU Spanish KAP Older Child 6. ES Paper Questionnaire - KAP Older Child.docx	Form and Instruction
0920-18ANU Spanish KAP Younger Child 6. ES Paper Questionnaire - KAP Younger Child.docx	Form and Instruction
0920-18ANU Year Two Combined Questionnaire 6. Attachment_6 EN ES Y2 Paper Questionnaire - COMBINED 03.25.2019.pdf	Form and Instruction

IC Title:

Knowledge, Attitudes, and Practices Individual Questionnaire

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?	Electronic Capability
Form and Instruction	0920-18ANU	KAP Adult	6. EN Paper Questionnaire - KAP Adult.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	KAP Older Child	6. EN Paper Questionnaire - KAP Older Child.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	KAP Younger Child	6. EN Paper Questionnaire - KAP Younger Child.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	Spanish KAP Adult	6. ES Paper Questionnaire - KAP Adult.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	Spanish KAP Older Child	6. ES Paper Questionnaire - KAP Older Child.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	Spanish KAP Younger Child	6. ES Paper Questionnaire - KAP Younger Child.docx	na	No	Fillable Fileable
Form and Instruction	0920-18ANU	Year Two Combined Questionnaire	6. Attachment_6 EN ES Y2 Paper Questionnaire - COMBINED 03.25.2019.pdf	NA	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 4,000

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
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	7,250	7,250

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.