Information Collection

Management Reporting Tool

IC 219387 under ICR 201512-0930-004 · OMB 0930-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0354 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Management Reporti Management Reporting Tool	Form and Instruction
Management Reporti Management Reporting Tool PeP-C_Wireframes_MRT_tool_6-10-2015_forCSAP.docx	Form and Instruction
Public_Burden_Statement-02022015.doc Burden_Statement	IC Document

IC Title:

Management Reporting Tool

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 and Instruction	Management Reporting Tool	Management Reporting Tool	PeP-C_Wireframes_MRT_tool_6-10-2015_forCSAP.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 69

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
Annual Number of Responses for this IC	438	438
Annual IC Time Burden (Hours)	1,107	1,107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden_Statement	Public_Burden_Statement-02022015.doc	12/22/2015

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