Information Collection

Mfp

IC 189380 under ICR 200905-0930-002 · OMB 0930-0304.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0304 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachments A-F MFP	Form and Instruction
Attachments A-F Attachments A-F MFP_OMB_survey_and_interview_protocols_v5.doc	Form and Instruction
MFP OMB_other information and resources.doc Attachments G & H	IC Document

IC Title:

MFP

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	Attachments A-F	Attachments A-F	MFP_OMB_survey_and_interview_protocols_v5.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,015

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	1,015	1,015
Annual IC Time Burden (Hours)	1,950	1,950
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachments G & H	MFP OMB_other information and resources.doc	05/19/2009

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