MUH Resident Baseline Survey - screening LA

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

Documents and Forms

Document Name Document Type
MUH Resident Baseline Survey - screening LA Form
MUH Resident Survey - LA (English) clean 12.17.13Att 8A(e)_MUH Resident Baseline Survey.doc Form
MUH Resident Survey - LA (Spanish) clean 12.17.13 Att 8A(s)_MUH Resident Baseline Survey_12.15.13.doc Form

Information Collection (IC) Details

IC Title:	MUH Resident Baseline Survey - screening LA	Agency IC Tracking Number:

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	none	MUH Resident Survey - LA (English)	clean 12.17.13Att 8A(e)_MUH Resident Baseline Survey.doc		Yes	No	Fillable Printable
Form	none	MUH Resident Survey - LA (Spanish)	clean 12.17.13 Att 8A(s)_MUH Resident Baseline Survey_12.15.13.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 833	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	833	833
Annual IC Time Burden (Hours)	69	69
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.