Information Collection

Summary Respondent Burden

IC 181319 under ICR 200707-0920-006 · OMB 0920-0007.

Documents and Forms

Document Name Document Type
Attachment-10 Annual Summary forms and tables (2-3-2006).doc Instruction
Attachment 10 Final Letter.pdf Summary Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Summary Respondent Burden	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
Instruction			Attachment-10 Annual Summary forms and tables (2-3-2006).doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 42 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	798	798
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Summary Letter	Attachment 10 Final Letter.pdf	07/13/2007

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