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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.