Information Collection

SPF-SIG - Community

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.