Information Collection

Co-Occurring

IC 185370 under ICR 200806-0930-002 · OMB 0930-0284.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Instruments Instruments Co-Occurring	Form and Instruction
Instruments Instruments Attachment A - Co-oc measures 080706.doc	Form and Instruction

IC Title:

Co-Occurring

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
Form and Instruction	Instruments				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 298

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	298	298
Annual IC Time Burden (Hours)	1,356	1,356
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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