Health Education Materials & Questionnaire - Inhaler

Development of a Health Information Rating System (HIRS)

Documents and Forms

Document Name Document Type
Form Form #3 Health Education Materials & Questionnaire - Inhaler Form and Instruction
Form #3 Health Education Materials & Questionnaire - Asthma/Inha Attachment E - Health Education Materials & Questionnaire - Asthma-Inhaler.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Education Materials & Questionnaire - Inhaler	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	Form #3	Health Education Materials & Questionnaire - Asthma/Inhaler	Attachment E - Health Education Materials & Questionnaire - Asthma-Inhaler.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	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	48	48
Annual IC Time Burden (Hours)	24	24
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.