Information Collection

Summary Respondent Burden

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.