Special Bacteriology Reference Laboratory Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0879 Special Bacteriology Reference Laboratory Assessment Form and Instruction
0920-0879 Attachment B- SBRL Instrument - Word Version Attachment B- SBRL Instrument - Word Version.docx Form and Instruction
0920-0879 Attachment C - SBRL Instrument - Web Version Screen Shot Attachment C - SBRL Instrument - Web Version Screen Shots.docx Form and Instruction
Attachment A - Laboratory Name and Type List.xlsx Attachment A - Laboratory Name and Type List IC Document
Attachment D - Laboratory Titles and Email List.xlsx Attachment D - Laboratory Titles and Email List IC Document
Attachment E- Email Introduction Letter.docx Attachment E- Email Introduction Letter IC Document
Attachment F- Email Introduction Reminder Letter.docx Attachment F- Email Introduction Reminder Letter IC Document
REV SBRL-SSA.docx REV SBRL-SSA IC Document
SBRL-SSB.docx SBRL-SSB IC Document

Information Collection (IC) Details

IC Title:	Special Bacteriology Reference Laboratory Assessment	Agency IC Tracking Number:	16AAV

IC Status: New

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	0920-0879	Attachment B- SBRL Instrument - Word Version	Attachment B- SBRL Instrument - Word Version.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Attachment C - SBRL Instrument - Web Version Screen Shots	Attachment C - SBRL Instrument - Web Version Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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	51	51
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A - Laboratory Name and Type List	Attachment A - Laboratory Name and Type List.xlsx	04/14/2016
Attachment D - Laboratory Titles and Email List	Attachment D - Laboratory Titles and Email List.xlsx	04/14/2016
Attachment E- Email Introduction Letter	Attachment E- Email Introduction Letter.docx	04/14/2016
Attachment F- Email Introduction Reminder Letter	Attachment F- Email Introduction Reminder Letter.docx	04/14/2016
REV SBRL-SSA	REV SBRL-SSA.docx	04/14/2016
SBRL-SSB	SBRL-SSB.docx	04/14/2016

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