NFR Enrollment Questionnaire

[NIOSH] National Firefighter Registry for Cancer

Documents and Forms

Document Name Document Type
NFR Enrollment Questionnaire Form and Instruction
Enrollment Questionnaire Attachment 3c._Enrollment_Questionnaire-508.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	NFR Enrollment Questionnaire	Agency IC Tracking Number:	0920-1348

Is this a Common Form? No		IC Status: New

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	n/a	Enrollment Questionnaire	Attachment 3c._Enrollment_Questionnaire-508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 66,666	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66,666	66,666
Annual IC Time Burden (Hours)	33,333	33,333
Annual IC Cost Burden (Dollars)	0	0

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.