Information Collection

GenIC XDRCI-COST

IC 222576 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_B_Introduction_to_the_TB_controller_and_solicitation_of_data_....docx	Instruction
Attachment_Ca_Data_Collection_instructions.docx	Instruction
Attachment_Cb_State_and_county_representative_data_collection_spreadshee....xlsx	Other-Excel
Attachment_Da_Information_transmitting_interview_guide_instrument_progra....docx	Instruction
Attachment_Db_Information_transmitting_interview_guide_instrument_accoun....docx	Instruction
Attachment_E_Phone_script_followup_instrument.docx	Other-WORD
XDRCI-COST-SSA.DOCX Sup Sta A	IC Document
XDRCI-COST-SSB.DOCX Sup Sta B	IC Document
Attachment_A_State_and_county_collaborators.docx Att A_ State and County Collaborators	IC Document
Attachment_F_Notification_Email_to_TB_Controller.docx Att F_Notification Email to TB Controller	IC Document
Attachment_G_Notification_Email_to_Respondent.docx Att G_Notification Email to Respondent	IC Document
Attachment_H_Reminder_email.docx Att H_Reminder Email	IC Document
Attachment_I_Email_to_set_up_validation_call.docx Att I_Email to Set-Up Validation Call	IC Document

IC Title:

GenIC XDRCI-COST

Agency IC Tracking Number:

16AVZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	Attachment_B_Introduction_to_the_TB_controller_and_solicitation_of_data_....docx	No	Paper Only
Instruction	Attachment_Ca_Data_Collection_instructions.docx	No	Paper Only
Other-Excel	Attachment_Cb_State_and_county_representative_data_collection_spreadshee....xlsx	No	Fillable Fileable
Instruction	Attachment_Da_Information_transmitting_interview_guide_instrument_progra....docx	No	Paper Only
Instruction	Attachment_Db_Information_transmitting_interview_guide_instrument_accoun....docx	No	Paper Only
Other-WORD	Attachment_E_Phone_script_followup_instrument.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sup Sta A	XDRCI-COST-SSA.DOCX	07/22/2016
Sup Sta B	XDRCI-COST-SSB.DOCX	07/22/2016
Att A_ State and County Collaborators	Attachment_A_State_and_county_collaborators.docx	07/22/2016
Att F_Notification Email to TB Controller	Attachment_F_Notification_Email_to_TB_Controller.docx	07/25/2016
Att G_Notification Email to Respondent	Attachment_G_Notification_Email_to_Respondent.docx	07/25/2016
Att H_Reminder Email	Attachment_H_Reminder_email.docx	07/25/2016
Att I_Email to Set-Up Validation Call	Attachment_I_Email_to_set_up_validation_call.docx	07/25/2016

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