Device Return

Cardiovascular Health and Needs Assessment in Washington, DC - Development of a Community-Based Behavioral Weight Loss Intervention (NHLBI)

Documents and Forms

Document Name Document Type
Form 1 Device Return Form and Instruction
1 Device Training Attachment 1 National Heart Lung and Blood Institute Protocol 13-H-0183.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Device Return	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Device Training	Attachment 1 National Heart Lung and Blood Institute Protocol 13-H-0183.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	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	15	15
Annual IC Time Burden (Hours)	5	5
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.