Information Collection

Annual Reporting Data Elements for RPE

IC 237591 under ICR 201908-0920-011 · OMB 0920-1286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1286 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-XXXX Annual Reporting Data Elements for RPE Form and Instruction
0920-XXXX Annual Reporting Data Elments for RPE Att_3a_Annual_Reporting_Data_Elements_for_RPE_Word_Version.pdf Form and Instruction
Att_3b_Annual_Reporting_Data_Elements_for_RPE_Screenshots.pdf Att 3b_Annual Reparoting Data Elments for RPE (screenshots) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Reporting Data Elements for RPE	Agency IC Tracking Number:	0920-19BOL

Is this a Common Form? No		IC Status: New

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 and Instruction	0920-XXXX	Annual Reporting Data Elments for RPE	Att_3a_Annual_Reporting_Data_Elements_for_RPE_Word_Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	220	220
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3b_Annual Reparoting Data Elments for RPE (screenshots)	Att_3b_Annual_Reporting_Data_Elements_for_RPE_Screenshots.pdf	08/29/2019

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