Information Collection

Individual Consumers: ETS health lesson learning questionnaires

IC 252921 under ICR 202204-0990-005 · OMB 0990-0482.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0482 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Individual Consumers: ETS health lesson learning questionnaires	Form and Instruction
Form 1 ETS Control Your Blood Pressure Individual Consumers: ETS health lesson learning questionnaires	Form and Instruction
Form 2 Salt and Cardiovascular Risk Individual Consumers: ETS health lesson learning questionnaires	Form and Instruction
Form 3 ET Get Active Individual Consumers: ETS health lesson learning questionnaires	Form and Instruction
1 ETS Control Your Blood Pressure Appendix D1_ETS Control Your Blood Pressure.pdf	Form and Instruction
1 ETS Control Your Blood Pressure Appendix D1_ETS Control Your Blood Pressure.pdf	Form and Instruction
2 Salt and Cardiovascular Risk Appendix D2_ETS Salt and Cardiovascular Risk.pdf	Form and Instruction
2 Salt and Cardiovascular Risk Appendix D2_ETS Salt and Cardiovascular Risk.pdf	Form and Instruction
3 ET Get Active Appendix D3_ETS Get Active.pdf	Form and Instruction
3 ET Get Active Appendix D3_ETS Get Active.pdf	Form and Instruction

IC Title:

Individual Consumers: ETS health lesson learning questionnaires

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR CFR 1320.8(d) (To search for a specific CFR, visit the Code of Federal Regulations.)

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	1	ETS Control Your Blood Pressure	Appendix D1_ETS Control Your Blood Pressure.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Salt and Cardiovascular Risk	Appendix D2_ETS Salt and Cardiovascular Risk.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	ET Get Active	Appendix D3_ETS Get Active.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Individual Consumers: ETS health lesson learning questionnaires

FR Citation: 86 FR 70510

Number of Respondents: 3,120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	3,120	3,120
Annual IC Time Burden (Hours)	1,872	1,872
Annual IC Cost Burden (Dollars)	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.