Information Collection

Bi/Trienniel Follow-Up

IC 190833 under ICR 201211-0925-004 · OMB 0925-0522.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0522 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Bi/Trienniel Follow-Up	Form and Instruction
1 SIS_Triennial_Forms_20121018_Att 2A SIS_Triennial_Forms_20121018_Att 2A.pdf	Form and Instruction
1 SIS_Biennial_Triennial_FollowupScripts_20121018_Att 2C SIS_Biennial_Triennial_FollowupScripts_20121018_Att 2C.pdf	Form and Instruction
SIS_Triennial_Correspondence_20121018_Att 2B.pdf SIS_Triennial_Correspondence_20121018_Att 2B.pdf	IC Document

IC Title:

Bi/Trienniel Follow-Up

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	1	SIS_Triennial_Forms_20121018_Att 2A	SIS_Triennial_Forms_20121018_Att 2A.pdf		No		Paper Only
Form and Instruction	1	SIS_Biennial_Triennial_FollowupScripts_20121018_Att 2C	SIS_Biennial_Triennial_FollowupScripts_20121018_Att 2C.pdf		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,961

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16,961	-33,039	50,000
Annual IC Time Burden (Hours)	21,201	-41,299	62,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SIS_Triennial_Correspondence_20121018_Att 2B.pdf	SIS_Triennial_Correspondence_20121018_Att 2B.pdf	01/22/2013

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