OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Individual Questionnaire

IC 234594 under ICR 202204-0920-005 · OMB 0920-1254.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Individual Questionnaire 0920-1254
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-18ANU Individual Questionnaire 5. EN Paper Questionnaire - Individual.docx na No   Fillable Fileable
Form and Instruction 0920-18ANU Individual Questionnaire Spanish 5. ES Paper Questionnaire - Individual.docx na No   Fillable Fileable
Form and Instruction 0920-1254 Individual Questionnaire - Data Collection Instruments (combined English/Spanish) Attachment 3_COPA Data Collection Instruments_combined 07APR2022.pdf NA No   Fillable Fileable

Health Public Health Monitoring

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

3,800 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,800 0 -200 0 4,000 0
Annual IC Time Burden (Hours) 1,267 0 267 0 1,000 0
Annual IC Cost Burden (Dollars) 10,770 0 3,520 0 7,250 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.