Information Collection

Cyclosporiasis National Hypothesis Generating Questionnaire

IC 226341 under ICR 202309-0920-007 · OMB 0920-1198.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1198 Cyclosporiasis National Hypothesis Generating Questionnaire	Form and Instruction
0920-1198 Cyclosporiasis National Hypothesis Generating Questionna Attachment E. CNHGQ 2021_fillable.pdf	Form and Instruction
0920-1198 Cyclosporiasis National Hypothesis Generating Questionna Attachment E. CNHGQ 2021_fillable.pdf	Form and Instruction
Attachment D. CNHGQ_2021_EpiInfoWebSurvey.pdf Attachment D. CNHGQ_2021_EpiInfoWebSurvey	IC Document
Attachment D. CNHGQ_2021_EpiInfoWebSurvey.pdf Attachment D. CNHGQ_2021_EpiInfoWebSurvey	IC Document
Attachment F. Determination of Non-Applicability of Human Subjects Regulations.pdf Determination	IC Document
Attachment F. Determination of Non-Applicability of Human Subjects Regulations.pdf Determination	IC Document

IC Title:

Agency IC Tracking Number:

0920-1198

Is this a Common Form? No

IC Status: Modified

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	0920-1198	Cyclosporiasis National Hypothesis Generating Questionnaire	Attachment E. CNHGQ 2021_fillable.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

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	Previously Approved
Annual Number of Responses for this IC	2,500	0	2,500
Annual IC Time Burden (Hours)	1,875	0	1,875
Annual IC Cost Burden (Dollars)	0	-46,838	46,838

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D. CNHGQ_2021_EpiInfoWebSurvey	Attachment D. CNHGQ_2021_EpiInfoWebSurvey.pdf	09/14/2023
Determination	Attachment F. Determination of Non-Applicability of Human Subjects Regulations.pdf	09/14/2023

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