Information Collection

Survey Study -- Current State and Local Government Agencies

IC 202583 under ICR 201511-0910-003 · OMB 0910-0726.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey Cover Letter and Census Directions FINAL 8-31-12.doc	Other-Cover Letter and Directions
SURVEY 205(c) FINAL 9-27-12.doc	Other-Survey
FSMA 205c2 Draft Reminder FINA 8-31-12L.doc	Other-Reminder

IC Title:

Agency IC Tracking Number:

ORA

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter and Directions	Survey Cover Letter and Census Directions FINAL 8-31-12.doc	Yes	No	Printable Only
Other-Survey	SURVEY 205(c) FINAL 9-27-12.doc	Yes	Yes	Fillable Fileable
Other-Reminder	FSMA 205c2 Draft Reminder FINA 8-31-12L.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,391

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	Previously Approved
Annual Number of Responses for this IC	1,391	1,391
Annual IC Time Burden (Hours)	1,391	1,391
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.