Information Collection

Irlcw

IC 224493 under ICR 201611-0925-004 · OMB 0925-0751.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 IRLCW	Form
2 Initial Review Local Context Worksheet (IRLCW) Attachment 3 Initial Review Local Context Worksheet (IRLCW).docx	Form

IC Title:

IRLCW

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	2	Initial Review Local Context Worksheet (IRLCW)	Attachment 3 Initial Review Local Context Worksheet (IRLCW).docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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