Information Collection

6-Month Survey

IC 244217 under ICR 202310-0920-003 · OMB 0920-1333.

Documents and Forms

Document Name Document Type
Form 0920-20FO 6-Month Survey Form and Instruction
0920-20FO Att.4i-Month 6 Survey-Revised Att.4i-Month 6 Survey-Revised.docx Form and Instruction
0920-20FO Att.4i-Month 6 Survey-Revised Att.4i-Month 6 Survey-Revised.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	6-Month Survey	Agency IC Tracking Number:	092-20FO

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20FO	Att.4i-Month 6 Survey-Revised	Att.4i-Month 6 Survey-Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160, Records of Subjects in Health Promotion and Education Studies	FR Citation: 51 FR 42434

Number of Respondents: 1,046	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,046	0	1,046
Annual IC Time Burden (Hours)	262	0	262
Annual IC Cost Burden (Dollars)	0	-7,437	7,437

Documents for IC

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.