Information Collection

SDY Module - State Health Personnel

IC 217617 under ICR 201902-0920-005 · OMB 0920-1092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1092 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SDY Module - State Health Personnel	Form
NCFRP Cases Reporting System SDY Module 1 Att 7a_NCFRP Case Reporting System_Module I.docx	Form

IC Title:

SDY Module - State Health Personnel

Agency IC Tracking Number:

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	none	NCFRP Cases Reporting System SDY Module 1	Att 7a_NCFRP Case Reporting System_Module I.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14

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	742	742
Annual IC Time Burden (Hours)	124	124
Annual IC Cost Burden (Dollars)	2,337	2,337

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.