Information Collection

N-ssats

IC 191114 under ICR 201510-0930-004 · OMB 0930-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Between Cycles N-S Between Cycles N-SSATS - A N-SSATS	Form and Instruction
Form N-SSATS 2016 quest N-SSATS 2016 questionnaire - B N-SSATS	Form and Instruction
Form N-SSATS 2016 CATI N-SSATS 2016 CATI questionnaire N-SSATS	Form and Instruction
Between Cycles N-S Between Cycles N-SSATS - A Attachment B1- N-SSATS 2017 questionnaire (Version A).pdf	Form and Instruction
N-SSATS 2016 quest N-SSATS 2016 questionnaire - B Attachment B2- N-SSATS 2016 questionnaire (Version B).pdf	Form and Instruction
N-SSATS 2016 CATI N-SSATS 2016 CATI questionnaire Attachment B5- N-SSATS 2016 CATI questionnaire.pdf	Form and Instruction
Attachment B4- N-SSATS 2016 screens for online questionnaire.pdf N-SSATS 2016 screens	IC Document
Attachment B6-N-SSATS 2016 Advance Letter.docx N-SSATS 2016 Advance Letter	IC Document
Attachment B7- N-SSATS 2016 cover letter, online questionnaire access instructions, and frequently asked questions sheet.docx N-SSATS 2016 cover letter, online questionnaire access	IC Document
Attachment B8- N-SSATS 2016 thank you_reminder letter.docx N-SSATS 2016 thank you	IC Document
Attachment B9- N-SSATS 2016 second mailing cover letter .docx N-SSATS 2016 second mailing	IC Document
Attachment B10- NSSATS Third Mailing Cover Letter..docx NSSATS Third Mailing	IC Document
Attachment B11- N-SSATS 2016 completion thank you letter.docx N-SSATS 2016 completion thank you	IC Document
Attachment B13- Web pages for the 2016 N-SSATS information website .pdf Web pages for the 2016 N-SSATS	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

N-SSATS

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Between Cycles N-SSATS - A	Yes	Yes	Fillable Fileable
Form and Instruction	N-SSATS 2016 questionnaire - B	Yes	Yes	Fillable Fileable
Form and Instruction	N-SSATS 2016 CATI questionnaire	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,000

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17,000	0	17,000
Annual IC Time Burden (Hours)	10,370	510	9,860
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
N-SSATS 2016 screens		10/08/2015
N-SSATS 2016 Advance Letter		10/08/2015
N-SSATS 2016 cover letter, online questionnaire access		10/08/2015
N-SSATS 2016 thank you		10/08/2015
N-SSATS 2016 second mailing		10/08/2015
NSSATS Third Mailing		10/08/2015
N-SSATS 2016 completion thank you		10/08/2015
Web pages for the 2016 N-SSATS		10/08/2015

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

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