Information Collection

Collaborators/Partners

IC 194046 under ICR 201010-0930-001 · OMB 0930-0317.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Partner-Collaborat Collaborators/Partners	Form and Instruction
Partner-Collaborat Partner-Collaborator Instruments Attachment 7-Partner-Collaborator Instruments.pdf	Form and Instruction
Attachment 8-Partner-Collaborator Other.pdf Partner-Collaborator Other	IC Document

IC Title:

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	Partner-Collaborator Instruments	Partner-Collaborator Instruments	Attachment 7-Partner-Collaborator Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	160	160
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Partner-Collaborator Other	Attachment 8-Partner-Collaborator Other.pdf	10/20/2010

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