Information Collection

N-ssats Bc

IC 191116 under ICR 201605-0930-002 · OMB 0930-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Between Cycles N-S N-SSATS BC	Form and Instruction
Between Cycles N-S Between Cycles N-SSATS Attachment B3- Between Cycles N-SSATS (N-SSATS BC).pdf	Form and Instruction
Between Cycle N-SS Between Cycle N-SSATS (N-SSATS BC) Attachment B3 - Between Cycle N-SSATS (N-SSATS BC).pdf	Form and Instruction
Attachment B12- Between Cycle N-SSATS (N-SSATS BC) advance letter.docx Between Cycles N-SSATS Letter	IC Document

IC Title:

N-SSATS BC

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	Between Cycles N-SSATS	Between Cycles N-SSATS	Attachment B3- Between Cycles N-SSATS (N-SSATS BC).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	Between Cycle N-SSATS (N-SSATS BC)	Between Cycle N-SSATS (N-SSATS BC)	Attachment B3 - Between Cycle N-SSATS (N-SSATS BC).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Between Cycles N-SSATS Letter	Attachment B12- Between Cycle N-SSATS (N-SSATS BC) advance letter.docx	10/08/2015

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