Information Collection

'sspractice'

IC 228417 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⚠️ Notice: This information collection may be referencing outdated material.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
AttachmentB_SSPractice_InterviewGuide.docx	Other-WORD
SSPRACTICE-SSA.docx SupSta A	IC Document
SSPRACTICE-SSB.docx SupSta B	IC Document
Attachement A_Respondent Universe.docx Att A_Respondent Universe	IC Document
AttachmentC_SSPractice_Invitation_Email.docx Att C_Invitation Email	IC Document

IC Title:

'SSPRACTICE'

Agency IC Tracking Number:

17BBA

IC Status: New

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			AttachmentB_SSPractice_InterviewGuide.docx		No		Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31

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	31	31
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SupSta A	SSPRACTICE-SSA.docx	09/21/2017
SupSta B	SSPRACTICE-SSB.docx	09/21/2017
Att A_Respondent Universe	Attachement A_Respondent Universe.docx	09/21/2017
Att C_Invitation Email	AttachmentC_SSPractice_Invitation_Email.docx	09/21/2017

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