Information Collection

ABLES Case Records Form and Brief Narrative Report

IC 231453 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⚠️ Notice: This information collection may be referencing outdated material.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 ABLES Case Records Form and Brief Narrative Report	Form and Instruction
0920-0931 ABLES Case Records Form and Brief Narrative Report Att7a ABLES Case Records Form.xlsx	Form and Instruction

IC Title:

ABLES Case Records Form and Brief Narrative Report

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	ABLES Case Records Form and Brief Narrative Report	Att7a ABLES Case Records Form.xlsx	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: 32

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	32	32
Annual IC Time Burden (Hours)	256	256
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.