Information Collection

Community Survey - Eligible High-Risk Heterosexual Individuals

IC 200569 under ICR 201112-0920-015 · OMB 0920-0922.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0922 can be found here:

Documents and Forms

Document Name Document Type
Rev Attach 9a Community Survey Interviewer Script.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community Survey - Eligible High-Risk Heterosexual Individuals	Agency IC Tracking Number:

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
Instruction			Rev Attach 9a Community Survey Interviewer Script.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	250	250
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.