Household respondents survey instrument (control group)

Measuring the Psycho-Social Impact on Communities Affected by Landmines and Unexploded Ordnance

Documents and Forms

Document Name Document Type
Form 2 Household respondents survey instrument (control group) Form
2 Instrument for Household Survey-Control Group Appendix 3a - survey instrument--LebanonQuantitative 10-15-0_sa.doc Form

Information Collection (IC) Details

IC Title:	Household respondents survey instrument (control group)	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
Form	2	Instrument for Household Survey-Control Group	Appendix 3a - survey instrument--LebanonQuantitative 10-15-0_sa.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

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)	600	600
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.