Information Collection

New MIS Modules: Success Stories & Environmental Assessment

IC 184680 under ICR 201004-0920-005 · OMB 0920-0739.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0739 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number New MIS Modules: Success Stories & Environmental Assessment	Form
No number Attachment A - New MIS Modules Attachment A. New MIS Modules.doc	Form

IC Title:

New MIS Modules: Success Stories & Environmental Assessment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	No number	Attachment A - New MIS Modules	Attachment A. New MIS Modules.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4	4
Annual IC Time Burden (Hours)	-44	44
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.