Information Collection

Fire Fighters Follow-back Survey

IC 231809 under ICR 202109-0920-012 · OMB 0920-1244.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1244 Fire Fighters Follow-back Survey	Form and Instruction
0920-1244 Fire Fighter Follow-back Survey revised Attachment C Firefighter_Survey.docx	Form and Instruction
0920-1244 Fire Fighter Follow-back Survey revised Attachment C Firefighter_Survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1244

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	0920-1244	Fire Fighter Follow-back Survey revised	Attachment C Firefighter_Survey.docx	NA	No		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: 35

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	-205	240
Annual IC Time Burden (Hours)	18	-102	120
Annual IC Cost Burden (Dollars)	454	-2,461	2,915

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.