OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Client-Level

IC 46632 under ICR 201003-0930-005 · OMB 0930-0285.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

View Information Collection (IC)

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:

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	Client-Level Instruments	Client-Level Instruments	Instruments.zip		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	15,681	0	-1,874	0	0	17,555
Annual IC Time Burden (Hours)	11,921	0	6,070	0	0	5,851
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
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.