Information Collection

Phase 2 - Panel, web Survey

IC 239161 under ICR 202001-0920-001 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Phase 2 - Panel, web Survey	Form and Instruction
Panel, web Survey AttE.2A_Web Survey_12.13.19.docx	Form and Instruction
Panel, web Survey screenshots AttE.2B_Web Survey Screenshots.docx	Form and Instruction

IC Title:

Phase 2 - Panel, web Survey

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Panel, web Survey	AttE.2A_Web Survey_12.13.19.docx		Yes	Yes	Fillable Fileable
Form and Instruction	none	Panel, web Survey screenshots	AttE.2B_Web Survey Screenshots.docx		Yes	Yes	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: 667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	667	667
Annual IC Time Burden (Hours)	278	278
Annual IC Cost Burden (Dollars)	7,337	7,337

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.