Information Collection

CBLS Variables - FY17 State or Local Health Departments

IC 231450 under ICR 201805-0920-004 · OMB 0920-0931.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0931 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0931 CBLS Variables - FY17 State or Local Health Departments	Form and Instruction
0920-0931 CBLS Variables - Text Files Att6b CBLS Variables Txt Files.doc	Form and Instruction

IC Title:

CBLS Variables - FY17 State or Local Health Departments

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 and Instruction	0920-0931	CBLS Variables - Text Files	Att6b CBLS Variables Txt Files.doc	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 âEpidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 14

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	56	56
Annual IC Time Burden (Hours)	224	224
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.