Vcassess

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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment B - Mosquito Control Program Questionnaire - Word Version.docx Other-WORD
Attachment C - Mosquito Control Program Questionnaire - Web Version.docx Other-WEB VERSION
Attachment A - Sample Breakdown.docx Att A_Sample Breakdown IC Document
Attachment D - Notification Email.docx Att D_Notification Email IC Document
Attachment E - Reminder Email.docx Att E_Reminder Email IC Document
VCASSESS-SSA.docx Supporting Statement A IC Document
VCASSESS-SSB.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	VCASSESS	Agency IC Tracking Number:	17ACD

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
Other-WORD			Attachment B - Mosquito Control Program Questionnaire - Word Version.docx		Yes	Yes	Fillable Fileable
Other-WEB VERSION			Attachment C - Mosquito Control Program Questionnaire - Web Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,181	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	2,181	2,181
Annual IC Time Burden (Hours)	273	273
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att A_Sample Breakdown	Attachment A - Sample Breakdown.docx	04/04/2017
Att D_Notification Email	Attachment D - Notification Email.docx	04/04/2017
Att E_Reminder Email	Attachment E - Reminder Email.docx	04/04/2017
Supporting Statement A	VCASSESS-SSA.docx	04/07/2017
Supporting Statement B	VCASSESS-SSB.docx	04/07/2017

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