Information Collection

Crlcw

IC 224494 under ICR 201611-0925-004 · OMB 0925-0751.

Documents and Forms

Document Name Document Type
Form 3 CRLCW Form
3 Continuing Review Local Context Worksheet (CRLCW) Attachment 4 Continuing Review Local Context Worksheet(CRLCW).docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CRLCW	Agency IC Tracking Number:

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
Form	3	Continuing Review Local Context Worksheet (CRLCW)	Attachment 4 Continuing Review Local Context Worksheet(CRLCW).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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.