Information Collection

Ohio Health/T.O.P.P.

IC 201758 under ICR 201203-0990-004 · OMB 0990-0382.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0382 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0382Attachment B_OHIO.pdf	Other-survey
2_OhioHealth PPA FU _response to OMB_051412.docx	Other-Survey

IC Title:

Ohio Health/T.O.P.P.

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-Survey			2_OhioHealth PPA FU _response to OMB_051412.docx		Yes	Yes	Printable Only
Other-survey			0990-0382Attachment B_OHIO.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 170

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	510	510
Annual IC Time Burden (Hours)	357	357
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.