Information Collection

Client FG

IC 194042 under ICR 201010-0930-001 · OMB 0930-0317.

Documents and Forms

Document Name Document Type
Form Client Instruments Client FG Form and Instruction
Client Instruments Client Instruments Attachment 1A-Client Instruments.pdf Form and Instruction
Client Instruments Client Instruments Attachment 1B-Client Instrument-cont'd.pdf Form and Instruction
Attachment 2A-Client Other.pdf Client Other IC Document
Attachment 2B-Client Other-cont'd.pdf Client Other IC Document
Attachment 2C-Client Other-cont'd-2.pdf Client Other IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Client FG	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 Instruments	Client Instruments	Attachment 1A-Client Instruments.pdf		Yes	Yes	Paper Only
Form and Instruction	Client Instruments	Client Instruments	Attachment 1B-Client Instrument-cont'd.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	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
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Client Other	Attachment 2A-Client Other.pdf	10/20/2010
Client Other	Attachment 2B-Client Other-cont'd.pdf	10/20/2010
Client Other	Attachment 2C-Client Other-cont'd-2.pdf	10/20/2010

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