Information Collection

PEMS Data Collection for Health Jurisdictions

IC 7165 under ICR 201108-0920-006 · OMB 0920-0696.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0696 can be found here:

Documents and Forms

Document Name Document Type
PEMS Data Collection for Health Jurisdictions Form
NHM&E Variables Attachment 5 NHME Variables and Values.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PEMS Data Collection for Health Jurisdictions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NHM&E Variables	Attachment 5 NHME Variables and Values.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	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	Previously Approved
Annual Number of Responses for this IC	260	0	260
Annual IC Time Burden (Hours)	38,428	2,548	35,880
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.