Information Collection

Infrastructure, Development, Prevention MH Abstraction

IC 192393 under ICR 201612-0930-003 · OMB 0930-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Result Form Infrastructure, Development, Prevention MH Abstraction	Form and Instruction
Result Form Result Form Attachment 3 IPP_RESULT FORM.docx	Form and Instruction

IC Title:

Infrastructure, Development, Prevention MH Abstraction

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Result Form	Result Form	Attachment 3 IPP_RESULT FORM.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 982

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	3,928	3,928
Annual IC Time Burden (Hours)	7,856	7,856
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.