Information Collection

Progress Report

IC 220629 under ICR 201603-0930-006 · OMB 0930-0362.

Documents and Forms

Document Name Document Type
Form Quarterly Report Progress Report Form and Instruction
Quarterly Report Quarterly Report CSAT PPW_OMB_Attachment 1_Quarterly Report_11_18_15.docx Form and Instruction
PPW_OMB Attachment_2_Results Pilot Test_9.24.15.docx Results Pilot Test IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Progress Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Quarterly Report	Quarterly Report	CSAT PPW_OMB_Attachment 1_Quarterly Report_11_18_15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Results Pilot Test	PPW_OMB Attachment_2_Results Pilot Test_9.24.15.docx	03/15/2016

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