Information Collection

SPF-SIG - Community

IC 191137 under ICR 201311-0930-001 · OMB 0930-0279.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CLI Part I SPF-SIG - Community	Form and Instruction
CLI Part I CLI Part I A1c - CLI Part I 7-22-13.doc	Form and Instruction
CLI Part II CLI Part II A1d - CLI Part II 7-22-13.doc	Form and Instruction

IC Title:

SPF-SIG - Community

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	CLI Part I	CLI Part I	A1c - CLI Part I 7-22-13.doc		Yes	Yes	Fillable Printable
Form and Instruction	CLI Part II	CLI Part II	A1d - CLI Part II 7-22-13.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 510

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
Annual Number of Responses for this IC	10,710	10,710
Annual IC Time Burden (Hours)	5,738	5,738
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.