Information Collection

Progress Report

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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.