Information Collection

57.600 State Health Department Validation Record

IC 208412 under ICR 201508-0920-001 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.600 57.600 State Health Department Validation Record	Form
CDC 57.600 State Health Department Validation Record 57.600_State HD Validation Record_BLANK.DOCX	Form
Att G.16_State Validation Record.pdf Att G.16_Table X. Instructions for Completion of State Health Department Validation Record form	IC Document

IC Title:

57.600 State Health Department Validation Record

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	CDC 57.600	State Health Department Validation Record	57.600_State HD Validation Record_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 152

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-7,600	7,600
Annual IC Time Burden (Hours)	-1,900	1,900
Annual IC Cost Burden (Dollars)	-59,622	59,622

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G.16_Table X. Instructions for Completion of State Health Department Validation Record form	Att G.16_State Validation Record.pdf	08/28/2014

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