Information Collection

CDCModel Performance Evaluation Program (MPEP) Laboratory Change Form

IC 182464 under ICR 200710-0920-010 · OMB 0920-0274.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 8 HIICF_domestic.doc	Other-Laboratory Change Form
Attachment 8 HIICF_earlyShip.doc Laboratory Change Form Foreign Countries	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
Other-Laboratory Change Form			Attachment 8 HIICF_domestic.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Laboratory Change Form Foreign Countries	Attachment 8 HIICF_earlyShip.doc	08/07/2007

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