Information Collection

WTC Health Registry Staff

IC 234101 under ICR 201911-0920-009 · OMB 0920-1252.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
WTC Health Registry Staff	Form and Instruction
Brief Demographic Survey Att G_Brief Demo Survey_2018-11-14.pdf	Form and Instruction
Focus group guide WTCHP Att D_FG protocol_2019-11.22.19 for OMB_clean.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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 and Instruction	n/a	Brief Demographic Survey	Att G_Brief Demo Survey_2018-11-14.pdf		No		Paper Only
Form and Instruction	none	Focus group guide	WTCHP Att D_FG protocol_2019-11.22.19 for OMB_clean.docx		No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	614	614

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.