Information Collection

Follow-up Forms

IC 234553 under ICR 201812-0930-002 · OMB 0930-0383.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0383 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Follow-up Form - I Follow-up Forms	Form and Instruction
Follow-up Form - D Follow-up Form - Domestic Attachment 4_TTC Follow up Form_domestic_5_2_2019.doc	Form and Instruction
Follow-up Form - I Follow-up Form - International Attachment 5_TTC Follow up Form_International_5_2_2019.doc	Form and Instruction

IC Title:

Follow-up Forms

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	Follow-up Form - International	Follow-up Form - International	Attachment 5_TTC Follow up Form_International_5_2_2019.doc		Yes	Yes	Fillable Fileable
Form and Instruction	Follow-up Form - Domestic	Follow-up Form - Domestic	Attachment 4_TTC Follow up Form_domestic_5_2_2019.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,500

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	22,500	22,500
Annual IC Time Burden (Hours)	3,600	3,600
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.