Information Collection

CSAP/NOMs

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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.