Information Collection

LRN Biennial Requalification

IC 192291 under ICR 201902-0920-020 · OMB 0920-0850.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0850 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0850 LRN Biennial Requalification	Form and Instruction
0920-0850 Biennial Requalification Att 3a - Biennial Requalification.doc	Form and Instruction
Attachment 3a LRN Biennial Requalification data elements.doc Data Elements	IC Document

IC Title:

LRN Biennial Requalification

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 and Instruction	0920-0850	Biennial Requalification	Att 3a - Biennial Requalification.doc	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

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	Previously Approved
Annual Number of Responses for this IC	130	-20	150
Annual IC Time Burden (Hours)	260	-40	300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Elements	Attachment 3a LRN Biennial Requalification data elements.doc	02/28/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.