Information Collection

CSAT Client-Level Data

IC 213384 under ICR 201501-0930-004 · OMB 0930-0346.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSAT Instrument CSAT Client-Level Data	Form and Instruction
CSAT Instrument CSAT Instrument Attachment 6 Final CSAT Instrument 1.12.15.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	CSAT Instrument	CSAT Instrument	Attachment 6 Final CSAT Instrument 1.12.15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 887,756

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,257,647	1,257,647
Annual IC Time Burden (Hours)	321,085	321,085
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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