Symptom survey

[NCEH] Aerosols from cyanobacterial blooms: exposures and health effects in a highly exposed population

Documents and Forms

Document Name Document Type
Form 0920-1316 Symptom survey Form
0920-1316 Symptom survey Att7 Symptom Survey 20200212.docx Form
0920-1316 Symptom survey Att7 Symptom Survey 20200212.docx Form
0920-1316 Symptom Survey - Revised 10JUL2023 0929-1316 Change Request Att7 Symptom Survey 06212023 FINAL.docx Form
0920-1316 Symptom Survey - Revised 10JUL2023 0929-1316 Change Request Att7 Symptom Survey 06212023 FINAL.docx Form

Information Collection (IC) Details

IC Title:	Symptom survey	Agency IC Tracking Number:	0920-1316

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	0920-1316	Symptom survey	Att7 Symptom Survey 20200212.docx		Yes	Yes	Fillable Fileable
Form	0920-1316	Symptom Survey - Revised 10JUL2023	0929-1316 Change Request Att7 Symptom Survey 06212023 FINAL.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Epidemiologic studies and surveillance of disease problems.	FR Citation: 57 FR 62812

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	670	0	670
Annual IC Time Burden (Hours)	168	0	168
Annual IC Cost Burden (Dollars)	0	-4,087	4,087

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.