Information Collection

Cyclosporiasis National Hypothesis Generating Questionnaire

IC 226341 under ICR 202112-0920-011 · OMB 0920-1198.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1198 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Cyclosporiasis National Hypothesis Generating Questionnaire	Form and Instruction
Cyclosporiasis National Hypothesis Generating Questionna Att D_CNHGQ 2020 - Epi Info Survey.pdf	Form and Instruction
Cyclosporiasis National Hypothesis Generating Questionna Att D_CNHGQ 2020 - Epi Info Survey.pdf	Form and Instruction
Cyclosporiasis National Hypothesis Generating Questionna Att E_CNHGQ 2020 - PDF fillable.pdf	Form and Instruction
Cyclosporiasis National Hypothesis Generating Questionna Att E_CNHGQ 2020 - PDF fillable.pdf	Form and Instruction
0920-1198 Cyclosporiasis National Hypothesis Generating Questionna Attachment 1. Revised CNHGQ 2021_consolidated.docx	Form and Instruction
0920-1198 Cyclosporiasis National Hypothesis Generating Questionna Attachment 1. Revised CNHGQ 2021_consolidated.docx	Form and Instruction

IC Title:

Cyclosporiasis National Hypothesis Generating Questionnaire

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ) (electronic submission)	Att D_CNHGQ 2020 - Epi Info Survey.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ) (fax submission)	Att E_CNHGQ 2020 - PDF fillable.pdf	No		Fillable Printable
Form and Instruction	0920-1198	Cyclosporiasis National Hypothesis Generating Questionnaire_revised	Attachment 1. Revised CNHGQ 2021_consolidated.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	1,875	1,875
Annual IC Cost Burden (Dollars)	46,838	46,838

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.