Information Collection

Annual Recertificaion for STD amp; TB

IC 190351 under ICR 201307-0915-006 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annual Recertificaion for STD amp; TB	Form and Instruction
1 STD-Recert STD-Recert.pdf	Form and Instruction
2 TB-Recertification TB-Recertification.pdf	Form and Instruction

IC Title:

Annual Recertificaion for STD amp; TB

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	1	STD-Recert	STD-Recert.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	TB-Recertification	TB-Recertification.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,754

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	Previously Approved
Annual Number of Responses for this IC	2,754	2,754
Annual IC Time Burden (Hours)	1,377	1,377
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.