Information Collection

Web Site Registration

IC 194259 under ICR 201008-0930-006 · OMB 0930-0313.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0313 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 2 - Scr Web Site Registration	Form and Instruction
Attachment 1 - Scr Attachment 1 - Screen Shot Web Registration Form Attachment 1 - Screen shot of first Web registration form - Create Login.JPG	Form and Instruction
Attachment 2 - Scr Attachment 2 - Screen Shot Web Registration Form Attachment 2 - Screen shot of second Web registration form - Account Information.JPG	Form and Instruction
Attachment 4 - SAMHSA Data collection questions and Values_3_29_10.doc Attachment 4 - Questions and Values	IC Document

IC Title:

Web Site Registration

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	Attachment 2 - Screen Shot Web Registration Form	Attachment 2 - Screen Shot Web Registration Form	Attachment 2 - Screen shot of second Web registration form - Account Information.JPG		Yes	Yes	Paper Only
Form and Instruction	Attachment 1 - Screen Shot Web Registration Form	Attachment 1 - Screen Shot Web Registration Form	Attachment 1 - Screen shot of first Web registration form - Create Login.JPG		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41,200

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 Agency Discretion
Annual Number of Responses for this IC	41,200	41,200
Annual IC Time Burden (Hours)	1,360	1,360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4 - Questions and Values	Attachment 4 - SAMHSA Data collection questions and Values_3_29_10.doc	08/05/2010

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