Information Collection

ICRC Indicators Data Collection

IC 228641 under ICR 201708-0920-023 · OMB 0920-1216.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ICRC Indicators Data Collection	Form and Instruction
ICRC Indicators Data Collection Att 3a. ICRC Indicators Data Collection.docm	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	n/a	ICRC Indicators Data Collection	Att 3a. ICRC Indicators Data Collection.docm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	6,000	6,000

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.