Information Collection

Bi/Trienniel Follow-Up

IC 190833 under ICR 200909-0925-005 · OMB 0925-0522.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0522 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 survey Bi/Trienniel Follow-Up	Form and Instruction
Form 2 survey Bi/Trienniel Follow-Up	Form and Instruction
1 survey SISOMB2009att2.1ann&bipkg.pdf	Form and Instruction
2 survey SISOMB2009att2.2bcfu.pdf	Form and Instruction

IC Title:

Bi/Trienniel Follow-Up

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	1				Yes	Yes	Paper Only
Form and Instruction	2				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50,000	50,000
Annual IC Time Burden (Hours)	62,500	62,500
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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