Information Collection

Line Listings Billing Clerk

IC 204806 under ICR 201811-0920-007 · OMB 0920-0960.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0960 Line Listings Billing Clerk	Form
0920-0960 Customer Contact Q. Customer Contact.docx	Form

IC Title:

Agency IC Tracking Number:

0920-0960

Is this a Common Form? No

IC Status: Modified

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	0920-0960	Customer Contact	Q. Customer Contact.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

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

FR Citation: 57 FR 62821

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	25	-10	35
Annual IC Time Burden (Hours)	25	-80	105
Annual IC Cost Burden (Dollars)	0	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.