Information Collection

Attachment 12 DDT MIS Add Surveillance Sources Screen

IC 178776 under ICR 200702-0920-003 · OMB 0920-0479.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0479 can be found here:

Documents and Forms

Document Name Document Type
Attachment 12 DDT MIS Add Surveillance Sources Screen Form
DDT MIS Add Surveillance Sources Attachment 12 DDT MIS Add Surveillance Sources.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 12 DDT MIS Add Surveillance Sources Screen	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	DDT MIS Add Surveillance Sources	Attachment 12 DDT MIS Add Surveillance Sources.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	590	590
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.