Information Collection

Daily Active Monitoring Tracking Report - web

IC 215919 under ICR 201503-0920-019 · OMB 0920-1066.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Daily Active Monitoring Tracking Report - web	Form
Direct Active Monitoring Tracking Report - web AttD-Daily DAM Recording High Some EVD Risk - Web.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	none	Direct Active Monitoring Tracking Report - web	AttD-Daily DAM Recording High Some EVD Risk - Web.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,575	4,575
Annual IC Time Burden (Hours)	305	305
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.