Information Collection

Att G._Low Pressure Event Form

IC 204805 under ICR 201409-0920-014 · OMB 0920-0960.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0960 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
G.LPE Form (revised).docx	Other-WORD
Justification for Change 9-26-14.docx Justification for Change	IC Document

IC Title:

Att G._Low Pressure Event Form

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
Other-WORD			G.LPE Form (revised).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-01236 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 5

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	Previously Approved
Annual Number of Responses for this IC	20	17	3
Annual IC Time Burden (Hours)	49	47	2
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for Change	Justification for Change 9-26-14.docx	09/26/2014

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