Assessment of the Tuberculosis Laboratory Aggregate Report

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⚠️ Notice: This information collection may be referencing outdated material.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
Assessment of the Tuberculosis Laboratory Aggregate Report Form
Assessment of the TB Laboratory Aggregate Report Att C_Intrument-Web Version.docx Form
EVAL-TB-AG-SSA.docx Supporting Statement A IC Document
EVAL-TB-AG-SSB.docx Supporting Statement B IC Document
Att A_Public Health Laboratories.docx Public Health Laboratories IC Document
Att B_Instrument-Word Version.docx Survey - word IC Document
Att D_Notification Email.docx Notification Email IC Document
Att E_Reminder Email.docx Reminder Email IC Document

Information Collection (IC) Details

IC Title:	Assessment of the Tuberculosis Laboratory Aggregate Report	Agency IC Tracking Number:	16BEZ

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	none	Assessment of the TB Laboratory Aggregate Report	Att C_Intrument-Web Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 58	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	58	58
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	EVAL-TB-AG-SSA.docx	09/26/2016
Supporting Statement B	EVAL-TB-AG-SSB.docx	09/26/2016
Public Health Laboratories	Att A_Public Health Laboratories.docx	09/26/2016
Survey - word	Att B_Instrument-Word Version.docx	09/26/2016
Notification Email	Att D_Notification Email.docx	09/26/2016
Reminder Email	Att E_Reminder Email.docx	09/26/2016

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