Information Collection

PHHS Block Grant Management Information System (BG-MIS) Annual Report

IC 184866 under ICR 200805-0920-004 · OMB 0920-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach 5A Annual Report Instrument.doc	Other-WORD
Attach 5B Annual Report Guidance.doc Guidance Document - Annual Report	IC Document

IC Title:

PHHS Block Grant Management Information System (BG-MIS) Annual Report

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attach 5A Annual Report Instrument.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	61	61
Annual IC Time Burden (Hours)	1,830	1,830
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Guidance Document - Annual Report	Attach 5B Annual Report Guidance.doc	04/28/2008

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