Information Collection

Adjustment to 2014Q3 Burden

IC 216238 under ICR 201502-0920-018 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0920-1011 Non-Substantive Change Request Memo_Y1Q3_03-02-2015.docx	Other-Burden Estimates
1011 genIC to adjust burden.docx Request for Approval	IC Document

IC Title:

Adjustment to 2014Q3 Burden

Agency IC Tracking Number:

15AEI

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-Burden Estimates			0920-1011 Non-Substantive Change Request Memo_Y1Q3_03-02-2015.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,281

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	6,281	6,281
Annual IC Time Burden (Hours)	2,944	2,944
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	1011 genIC to adjust burden.docx	04/22/2015

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