Aim 3 Telephone Questionnaire

Blood Donation Rules Opinion Study (Blood DROPS)

Documents and Forms

Document Name Document Type
Form 1 Aim 3 Telephone Questionnaire Form and Instruction
1 Telephone Questionaire MSM_OMB_Attach_3_Telephone_Q_5_2012_V_2 0.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Aim 3 Telephone Questionnaire	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 and Instruction	1	Telephone Questionaire	MSM_OMB_Attach_3_Telephone_Q_5_2012_V_2 0.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	20	20
Annual IC Time Burden (Hours)	40	20	20
Annual IC Cost Burden (Dollars)	0	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.