Information Collection

AIRS Interim and End of Year Report

IC 192746 under ICR 201304-0920-019 · OMB 0920-0853.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0853 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AIRS Interim and End of Year Report	Form
AIRS Data Collection Instrument 10 Attachment 4 AIRS Data Collection Instrument (web) 20130423.pdf	Form
11 Attachment 4 AIRS Data Collection Instrument (Word) 20130423.doc AIRS Data Collection Instrument (Word) 20130423	IC Document

IC Title:

AIRS Interim and End of Year Report

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	none	AIRS Data Collection Instrument	10 Attachment 4 AIRS Data Collection Instrument (web) 20130423.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AIRS Data Collection Instrument (Word) 20130423	11 Attachment 4 AIRS Data Collection Instrument (Word) 20130423.doc	04/30/2013

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