Information Collection

Output Record

IC 179585 under ICR 201307-0970-008 · OMB 0970-0161.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0161 can be found here:

Documents and Forms

Document Name Document Type
PRA - Output Record Spec 04-01-13.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Output Record	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
Instruction			PRA - Output Record Spec 04-01-13.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Location and Collection System	FR Citation: 78 FR 5812

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,808	2,808
Annual IC Time Burden (Hours)	1,292	1,292
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.