Health Services Questionnaire

NOAA Teacher-At-Sea Program

OMB: 0648-0283

IC ID: 207090

Information Collection (IC) Details

View Information Collection (IC)

Health Services Questionnaire
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NOAA Form 57-10-01 NOAA Health Services Questionnaire with Tuberculosis Screening Document NOAA Health Services Questionnaire.pdf Yes Yes Fillable Printable

Natural Resources Conservation, Marine and Land Management

COMMERCE/NOAA-22  81 FR 10576

45 0
   
Individuals or Households
 
   100 %

  Requested 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 45 0 0 0 0 45
Annual IC Time Burden (Hours) 34 0 0 0 0 34
Annual IC Cost Burden (Dollars) 0 0 0 -95 0 95

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

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