Information Collection

State Program Interim Reporting System (SPIRS)

IC 7137 under ICR 200906-0920-002 · OMB 0920-0669.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0669 can be found here:

Documents and Forms

Document Name Document Type
Form No number State Program Interim Reporting System (SPIRS) Form
No number Progress Monitoring Report Attachment C1 PMR.rev3.pdf Form
Attachment 1 Revised Survey 05-01-09.pdf Attachment 1 - Revised survey instrument IC Document
Attachment 2 Table of Data Revisions 05-01-09.doc Attachment 2 - Table of revisions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Program Interim Reporting System (SPIRS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	No number	Progress Monitoring Report	Attachment C1 PMR.rev3.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	25	-31	56
Annual IC Time Burden (Hours)	250	-422	672
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 1 - Revised survey instrument	Attachment 1 Revised Survey 05-01-09.pdf	05/20/2009
Attachment 2 - Table of revisions	Attachment 2 Table of Data Revisions 05-01-09.doc	05/21/2009

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