Information Collection

NEARS Data Recording Form

IC 221095 under ICR 201905-0920-008 · OMB 0920-0980.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0980 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0980 NEARS Data Recording Form	Form and Instruction
0920-0980 Data Recording Form NEARS revised instrument ICRO.docx	Form and Instruction

IC Title:

NEARS Data Recording Form

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	0920-0980	Data Recording Form	NEARS revised instrument ICRO.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	50	250
Annual IC Time Burden (Hours)	150	25	125
Annual IC Cost Burden (Dollars)	0	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.