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Federal forms, ICRs, and supporting documents

Information Collection

Phase II - 1,3,6 Months Form

IC 191374 under ICR 201212-0920-004 · OMB 0920-0843.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Phase II - 1,3,6 Months Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Phase II 1,3, and 6 months Forms Attachment_12_-_Phase_II_1_3_and_6_months_forms.doc No No Paper Only

Health Illness Prevention

 

54 6
   
Private Sector Businesses or other for-profits
 
   0 %

  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 324 0 0 0 0 324
Annual IC Time Burden (Hours) 135 0 0 0 0 135
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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