Information Collection

Street/Outreach Worker Suvey - KAP Body lice- and flea-borne diseases

IC 255799 under ICR 202209-0920-024 · OMB 0920-1372.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Street/Outreach Worker Suvey - KAP Body lice- and flea-borne diseases	Form and Instruction
KAP Survey - Steet/Outreach Worker Att_5_KAP_Street_Outreach.docx	Form and Instruction
KAP Survey - Steet/Outreach Worker Att_5_KAP_Street_Outreach.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	NA	KAP Survey - Steet/Outreach Worker	Att_5_KAP_Street_Outreach.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
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.