Information Collection

Progress Report

IC 226968 under ICR 201705-0920-012 · OMB 0920-1201.

Documents and Forms

Document Name Document Type
Att 5 Progress Report.docx Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Progress Report	Agency IC Tracking Number:	0920-17BZ

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
Other-WORD			Att 5 Progress Report.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	2,314	2,314

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.