Information Collection

ASA24 Screenshots

IC 190234 under ICR 200908-0925-001 · OMB 0925-0605.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0605 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 ASA24 Screenshots	Form and Instruction
2 ASA24 Attach2 - ASA24 Screenshots.pdf asa24.westat.com	Form and Instruction

IC Title:

ASA24 Screenshots

Agency IC Tracking Number:

Is this a Common Form?

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	2	ASA24	Attach2 - ASA24 Screenshots.pdf	http://asa24.westat.com	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 486

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	486	486
Annual IC Time Burden (Hours)	243	243
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.