Follow-Up Urine Collection Questionnaire

Salt Sources Study

Documents and Forms

Document Name Document Type
Follow-Up Urine Collection Questionnaire Form
Salt Sources Study--Follow-up Urine Collection Questionn Att 16A_Follow-Up Urine Collection Questionnaire8_28_2013.doc Form
Att 16B_Criteria for Redo Collection (Instructions for Study Staff).doc Att 16B_Criteria for Redo Collection (Instructions for Study Staff) IC Document

Information Collection (IC) Details

IC Title:	Follow-Up Urine Collection 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	none	Salt Sources Study--Follow-up Urine Collection Questionnaire	Att 16A_Follow-Up Urine Collection Questionnaire8_28_2013.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 252

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 16B_Criteria for Redo Collection (Instructions for Study Staff)	Att 16B_Criteria for Redo Collection (Instructions for Study Staff).doc	06/04/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.