Information Collection

Att C_NAMCS CLAS Questionnaire

IC 221651 under ICR 201605-0920-014 · OMB 0920-1119.

Documents and Forms

Document Name Document Type
Att C - Questionnaire 040416.pdf Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att C_NAMCS CLAS Questionnaire	Agency IC Tracking Number:	15BCU

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
Other-WORD			Att C - Questionnaire 040416.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 2,400	Number of Respondents for Small Entity: 336

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 4 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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