Information Collection

Annual Updates

IC 43630 under ICR 201602-0925-013 · OMB 0925-0522.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Annual Updates	Form and Instruction
1 Attachment 1 Annual Update screenshot SISOMB2016ATTACHMENT1cANNUALWebScreenShots20160219.pdf	Form and Instruction
SISOMB2016ATTACHMENT1aANNUALform20160219.pdf Attachment 1A Annual Form	IC Document
SISOMB2016ATTACHMENT1bANNUALcorrespondence20160219.pdf Attachment 1b Annual Correspondence	IC Document

IC Title:

Annual Updates

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment 1 Annual Update screenshot	SISOMB2016ATTACHMENT1cANNUALWebScreenShots20160219.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32,215

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	32,215	-1,708	33,923
Annual IC Time Burden (Hours)	5,369	-285	5,654
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1A Annual Form	SISOMB2016ATTACHMENT1aANNUALform20160219.pdf	02/22/2016
Attachment 1b Annual Correspondence	SISOMB2016ATTACHMENT1bANNUALcorrespondence20160219.pdf	02/22/2016

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