Information Collection

Section C: PFS Outcomes

IC 232354 under ICR 201807-0930-001 · OMB 0930-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0354 can be found here:

Documents and Forms

Document Name Document Type
Form PFS Section C: PFS Outcomes Form and Instruction
PFS PFS DSP_MRT_Attachment #4 PFS_8_15_18.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Section C: PFS Outcomes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	PFS	PFS	DSP_MRT_Attachment #4 PFS_8_15_18.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 71	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	71	71
Annual IC Time Burden (Hours)	213	213
Annual IC Cost Burden (Dollars)	0	0

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.