OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Adult Questionnaire

IC 239057 under ICR 202305-0923-001 · OMB 0923-0063.

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

View Information Collection (IC)

Adult Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Adult questionnaire M_Att16_AdltQstnnr_20200714_updt.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

SORN 09–19–0001, ‘‘Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances"  76 FR 4432

2,333 0
   
Individuals or Households
 
   100 %

  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 2,333 0 0 0 0 2,333
Annual IC Time Burden (Hours) 1,167 0 0 0 0 1,167
Annual IC Cost Burden (Dollars) 29,139 0 0 0 0 29,139

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.