Information Collection

N-ssats Bc

IC 191116 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form Between Cycles N-S N-SSATS BC Form and Instruction
Between Cycles N-S Between Cycles N-SSATS Attachment B3- Between Cycles N-SSATS (N-SSATS BC).pdf Form and Instruction
Attachment B12- Between Cycle N-SSATS (N-SSATS BC) advance letter.docx Between Cycles N-SSATS Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	N-SSATS BC	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Between Cycles N-SSATS	Between Cycles N-SSATS	Attachment B3- Between Cycles N-SSATS (N-SSATS BC).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Between Cycles N-SSATS Letter	Attachment B12- Between Cycle N-SSATS (N-SSATS BC) advance letter.docx	10/08/2015

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