Epidemiological Research Request -- State and Local Government

Epidemiological Research Request

OMB: 0960-0701

IC ID: 9755

Information Collection (IC) Details

View Information Collection (IC)

Epidemiological Research Request -- State and Local Government
 
No Modified
 
Voluntary
 
20 CFR 401.165

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Internet Screens Epidemiological Research Review Information, Application and Confidentiality Agreement - Revised Version.pdf http://www.socialsecurity.gov/ Yes Yes Fillable Fileable Signable

General Science and Innovation Scientific and Technological Research and Innovation

 

15 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15 0 0 0 0 15
Annual IC Time Burden (Hours) 30 0 0 0 0 30
Annual IC Cost Burden (Dollars) 54,975 0 0 54,975 0 0

Title Document Date Uploaded
Current Epidemiological Research Review Internet Screens Epidemiological Research Review Information, Application and Confidentiality Agreement - Current Version.pdf 12/23/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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