Information Collection

Advisory Council Report

IC 197697 under ICR 201705-0930-004 · OMB 0930-0169.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0169 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ACR Advisory Council Report	Form
ACR ACR Attachment 3 ACR 2.23.17 .docx	Form

IC Title:

Advisory Council Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	ACR	ACR	Attachment 3 ACR 2.23.17 .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	57	57
Annual IC Time Burden (Hours)	570	570
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.