Information Collection

Adjustment to Inventory for Y1Q4

IC 216260 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⚠️ Notice: This information collection may be referencing outdated material.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_Y1Q4_04-15-2015.docx	Other-Burden Inventory
1011 genIC to adjust burden.docx Adjustment to Burden for Y1Q4	IC Document

IC Title:

Adjustment to Inventory for Y1Q4

Agency IC Tracking Number:

15AEJ

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 Inventory			0920-1011 Non-Substantive Change Request Memo_Y1Q4_04-15-2015.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 296

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	296	296
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Adjustment to Burden for Y1Q4	1011 genIC to adjust burden.docx	04/23/2015

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