Information Collection

AHOBPR Questionnaire - Qarmat Ali Sub-population Follow-up

IC 235614 under ICR 201903-2900-001 · OMB 2900-0800.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10066 AHOBPR Questionnaire - Qarmat Ali Sub-population Follow-up	Form and Instruction
10-10066 AHOBPR Questionnaire - Qarmat Ali Sub-population Follow- AHOBR Questionnaire _ QA Sub-Pop Follow up.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

2900-0800

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	10-10066	AHOBPR Questionnaire - Qarmat Ali Sub-population Follow-up	AHOBR Questionnaire _ QA Sub-Pop Follow up.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 686

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	686	686
Annual IC Time Burden (Hours)	114	114
Annual IC Cost Burden (Dollars)	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.