Client-Level

Transformation Accountability (TRAC) Reporting System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0285 can be found here:

Documents and Forms

Document Name Document Type
Form Client-Level Instr Client-Level Form and Instruction
Client-Level Instr Client-Level Instruments Instruments.zip Form and Instruction
Att5. Public Comments in Response to Fed Reg Not.pdf Public Comments IC Document
Att6. Westat IRB Exemption.doc IRB Exemption IC Document

Information Collection (IC) Details

IC Title:	Client-Level	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Client-Level Instruments	Client-Level Instruments	Instruments.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,681	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,681	-1,874	17,555
Annual IC Time Burden (Hours)	11,921	6,070	5,851
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Public Comments	Att5. Public Comments in Response to Fed Reg Not.pdf	03/25/2010
IRB Exemption	Att6. Westat IRB Exemption.doc	03/25/2010

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