Information Collection

Post-Consultation Questionnaire

IC 249805 under ICR 202109-0920-005 · OMB 0920-1361.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Post-Consultation Questionnaire	Form and Instruction
Att 14a_Post-consultation questionnaire.docx	Other-WORD version of content to fac
Att 14a_Post-consultation questionnaire.docx	Other-WORD version of content to fac
Post-Consultation Questionnaire (screenshots) Att 14b_Post-consultation questionnaire_screenshots.docx	Form and Instruction
Post-Consultation Questionnaire (screenshots) Att 14b_Post-consultation questionnaire_screenshots.docx	Form and Instruction

IC Title:

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	n/a	Post-Consultation Questionnaire (screenshots)	Att 14b_Post-consultation questionnaire_screenshots.docx		Yes	Yes	Fillable Fileable
Other-WORD version of content to facilitate review			Att 14a_Post-consultation questionnaire.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems:(SORN) 09-20-0136

FR Citation: 57 FR 62812

Number of Respondents: 3

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	198	198

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.