Information Collection

Data Submission Layout - PRA BRFSS Coordinators

IC 228476 under ICR 201708-0920-024 · OMB 0920-1212.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Data Submission Layout - PRA BRFSS Coordinators	Form
Puerto Rico BRFSS Coordinator Electronic Datas Submissio ZRHCS_Data submission Layout.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	NA	Puerto Rico BRFSS Coordinator Electronic Datas Submission Layout	ZRHCS_Data submission Layout.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	3	3
Annual IC Time Burden (Hours)	9	9
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.