Information Collection

States - One-time SO/GI Survey

IC 235862 under ICR 201906-0920-007 · OMB 0920-0728.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0728 can be found here:

Documents and Forms

Document Name Document Type
States - One-time SO/GI Survey Form
SO/GI Survey Att 22 - SOGI Survey Data Collection Instrument.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	States - One-time SO/GI Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	SO/GI Survey	Att 22 - SOGI Survey Data Collection Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 76 FR 4458

Number of Respondents: 12	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	12	12
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	37	37

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.