Information Collection

BRSS TACS TA Survey

IC 225381 under ICR 201610-0930-005 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BRSS TACS TA Surve BRSS TACS TA Survey	Form and Instruction
BRSS TACS TA Surve BRSS TACS TA Survey BRSS TACS_OMB Attachment A Satisfaction Survey_011117.docx	Form and Instruction
BRSS TACS_OMB Attachment B Email to Respondents_12-21-16.docx Email to Respondents	IC Document
BRSS TACS_OMB Attachment C Screenshots_12-21-16.docx Screenshots	IC Document
BRSS TACS_OMB Supporting Statement_1.12.17.docx Supporting Statement	IC Document
Trans.Let-1-2017.doc Transmittal Letter	IC Document

IC Title:

BRSS TACS TA Survey

Agency IC Tracking Number:

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	BRSS TACS TA Survey	BRSS TACS TA Survey	BRSS TACS_OMB Attachment A Satisfaction Survey_011117.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email to Respondents	BRSS TACS_OMB Attachment B Email to Respondents_12-21-16.docx	01/27/2017
Screenshots	BRSS TACS_OMB Attachment C Screenshots_12-21-16.docx	01/27/2017
Supporting Statement	BRSS TACS_OMB Supporting Statement_1.12.17.docx	01/27/2017
Transmittal Letter	Trans.Let-1-2017.doc	01/27/2017

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