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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.