Non-CDC Study Supplement

Progress Report for Injury Control Research Centers (ICRC)

Documents and Forms

Document Name Document Type
Non-CDC Study Supplement Form and Instruction
ICRC IDC Non-CDC Study Supplement Att 3b. ICRC Indicators - Non-CDC Study Supple.docm Form and Instruction

Information Collection (IC) Details

IC Title:	Non-CDC Study Supplement	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	ICRC IDC Non-CDC Study Supplement	Att 3b. ICRC Indicators - Non-CDC Study Supple.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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	3,000	3,000

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.