OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Symptom survey

IC 240024 under ICR 202503-0920-004 · OMB 0920-1316.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1316
Symptom survey		 Form
Form 0920-1316
Symptom survey Symptom survey		 Form
Form 0920-1316
Symptom Survey - Revised 10JUL2023 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

View Information Collection (IC)

layout table

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 0920-1316 Yes Yes Fillable Fileable
Form 0920-1316 NA Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 670 0 0 0 0 670
Annual IC Time Burden (Hours) 168 0 0 0 0 168
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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