Information Collection

Annual Synar Report Format

IC 7625 under ICR 201901-0930-003 · OMB 0930-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0222 can be found here:

Documents and Forms

Document Name Document Type
FINAL FFY 2019 ASR Instructions_4.22.19.docx Instruction
ASR ASR FINAL FFY 2019 ASR_4.22.19.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Synar Report Format	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			FINAL FFY 2019 ASR Instructions_4.22.19.docx		Yes	Yes	Fillable Fileable
Form	ASR	ASR	FINAL FFY 2019 ASR_4.22.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	1,062	1,062
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.