Information Collection

CSAP/NOMs

IC 7638 under ICR 201302-0930-004 · OMB 0930-0230.

Documents and Forms

Document Name Document Type
Form NOMs Instruments CSAP/NOMs Form and Instruction
NOMs Instruments NOMs Instruments 128Attachment B NOMs Instruments (FINAL).docx Form and Instruction
128ATTACHMENT A NOMs 2.1.12.doc 128ATTACHMENT A NOMs 2.1.12 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CSAP/NOMs	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
Form and Instruction	NOMs Instruments	NOMs Instruments	128Attachment B NOMs Instruments (FINAL).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 77,877	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	133,781	-3,750	-43,246	180,777
Annual IC Time Burden (Hours)	53,512	-1,500	36,273	18,739
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
128ATTACHMENT A NOMs 2.1.12	128ATTACHMENT A NOMs 2.1.12.doc	02/09/2012

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