Information Collection

Community-Based Organizations - Agency Data

IC 180693 under ICR 201301-0920-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Attach5 PEB NHME Comprehensive DVS v11-02-2012.pdf Other-EvaluationWeb
Attach3B EW home page user.png Other-EvaluationWeb

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community-Based Organizations - Agency Data	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
Other-EvaluationWeb			Attach5 PEB NHME Comprehensive DVS v11-02-2012.pdf		Yes	Yes	Fillable Printable
Other-EvaluationWeb			Attach3B EW home page user.png		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	-800	1,200
Annual IC Time Burden (Hours)	200	-100,600	100,800
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.