Information Collection

CSAW Questionnaire

IC 237213 under ICR 202012-0920-012 · OMB 0920-1277.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1277 CSAW Questionnaire	Form and Instructi
0920-1277 CSAW Questionnaire Att 3 - CSAW Questionnaire.docx	Form and Instruction
0920-1277 CSAW Questionnaire Att 3 - CSAW Questionnaire.docx	Form and Instruction

IC Title:

CSAW Questionnaire

Agency IC Tracking Number:

0920-19VJ

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	0920-1277	CSAW Questionnaire	Att 3 - CSAW Questionnaire.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 627

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	627	0	627
Annual IC Time Burden (Hours)	418	104	314
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.