Information Collection

N-ssats

IC 191114 under ICR 201210-0930-005 · OMB 0930-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form N-SSATS 2013 web s N-SSATS 2013 web screens for on-line questionnaire N-SSATS	Form and Instruction
Form N-SSATS 2013 full N-SSATS 2013 full questionnaire N-SSATS	Form and Instruction
Form N-SSATS 2013 CATI N-SSATS 2013 CATI Questionnaire N-SSATS	Form and Instruction
N-SSATS 2013 full N-SSATS 2013 full questionnaire Attachment B1 - N-SSATS 2013 full questionnaire.docx	Form and Instruction
N-SSATS 2013 web s N-SSATS 2013 web screens for on-line questionnaire Attachment B3 - N-SSATS 2013 web screens for on-line questionnaire.pdf	Form and Instruction
N-SSATS 2013 CATI N-SSATS 2013 CATI Questionnaire Attachment B4 - N-SSATS 2013 CATI Questionnaire.pdf	Form and Instruction
Attachment B7 - N-SSATS 2013 Thank you reminder letter.docx N-SSATS 2013 Thank you reminder letter	IC Document
Attachment B5 - N-SSATS 2013 Advance Letter.docx N-SSATS 2013 Advance Letter	IC Document
Attachment B6 - N-SSATS 2013 Cover letter on-line instructions FAQ sheet.docx N-SSATS 2013 Cover letter on-line instructions FAQ sheet	IC Document
Attachment B8 - N-SSATS 2013 2nd mailing cover letter.docx N-SSATS 2013 2nd mailing cover letter	IC Document
Attachment B9 - N-SSATS 2013 Completion thank you letter.docx N-SSATS 2013 Completion thank you letter	IC Document
Attachment B11 - Web pages for the 2013 N-SSATS information website.pdf Web pages for the 2013 N-SSATS information website	IC Document
Attachment C1 - Expert panel - Nov 2011.docx Expert panel - Nov 2011	IC Document
Attachment C2 - Participant list - March 2011.doc Expert panel - Nov 2011	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

N-SSATS

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N-SSATS 2013 full questionnaire	Yes	Yes	Fillable Printable
Form and Instruction	N-SSATS 2013 web screens for on-line questionnaire	Yes	Yes	Fillable Printable
Form and Instruction	N-SSATS 2013 CATI Questionnaire	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,000

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	Previously Approved
Annual Number of Responses for this IC	17,000	0	17,000
Annual IC Time Burden (Hours)	9,860	-1,530	11,390
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
N-SSATS 2013 Thank you reminder letter		10/22/2012
N-SSATS 2013 Advance Letter		10/22/2012
N-SSATS 2013 Cover letter on-line instructions FAQ sheet		10/22/2012
N-SSATS 2013 2nd mailing cover letter		10/22/2012
N-SSATS 2013 Completion thank you letter		10/22/2012
Web pages for the 2013 N-SSATS information website		10/22/2012
Expert panel - Nov 2011		10/22/2012
Expert panel - Nov 2011		10/22/2012

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

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