Information Collection

Web Site Registration

IC 194259 under ICR 201306-0930-002 · OMB 0930-0313.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0313 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Screenshot of seco Web Site Registration	Form and Instruction
Screenshot of seco Screenshot of second web registration form Screenshot of second web registration form.jpg	Form and Instruction
Screenshot of firs Screenshot of first web registration form Screenshot of first web registration form.jpg	Form and Instruction
Attachment 4 - SAMHSA Data collection questions and Values 3.13 FINAL.doc SAMHSA Data collection questions and Values	IC Document

IC Title:

Web Site Registration

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 and Instruction	Screenshot of second web registration form	Screenshot of second web registration form	Screenshot of second web registration form.jpg		Yes	Yes	Fillable Printable
Form and Instruction	Screenshot of first web registration form	Screenshot of first web registration form	Screenshot of first web registration form.jpg		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 38,605

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	38,605	-2,595	41,200
Annual IC Time Burden (Hours)	1,286	-74	1,360
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SAMHSA Data collection questions and Values	Attachment 4 - SAMHSA Data collection questions and Values 3.13 FINAL.doc	06/12/2013

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