Information Collection

Work Activities Journal

IC 194610 under ICR 201009-0920-003 · OMB 0920-0874.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D-1. WAJ_09BV.xls	Other-WORD
Att D-2. WAJ Instructions_09BV_.doc	Other-WORD

IC Title:

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
Other-WORD			Att D-1. WAJ_09BV.xls		Yes	Yes	Fillable Printable
Other-WORD			Att D-2. WAJ Instructions_09BV_.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 368

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	368	368
Annual IC Time Burden (Hours)	736	736
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.