2021 Questionnaire

Medical Monitoring Project

OMB: 0920-0740

IC ID: 180565

Information Collection (IC) Details

View Information Collection (IC)

2021 Questionnaire 0920-0740
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none MMP Questionnaire 2021 - English Att 5a MMP 2021 Questionnaire English.pdf Yes Yes Fillable Fileable
Form and Instruction none MMP Questionnaire - Spanish Att 5b MMP 2021 Questionnaire Spanish.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

7,760 7,520
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,760 0 0 0 0 7,760
Annual IC Time Burden (Hours) 5,173 0 -647 0 0 5,820
Annual IC Cost Burden (Dollars) 134,015 0 7,314 0 0 126,701

Title Document Date Uploaded
MMP Questionnaire 2018 Att 5c MMP 2018 Questionnaire English.pdf 01/19/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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