Information Collection

Retrieving and Refiling Records - Public Agencies

IC 227708 under ICR 201909-0920-002 · OMB 0920-1128.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1128 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Retrieving and Refiling Records - Public Agencies	Form and Instruction
Att D SUDORS_Data_Elements_8_31_cl.docx	Other-Specifications for Data items
SUDORS Case Report - Retrieving and Refiling Records Att E. Retrieving and refiling records_1128_SUDORS.pdf	Form and Instruction
Att F1 1128_SUDORS_screen_Shots_8_31_cl.docx Screen Shots for SUDORS	IC Document

IC Title:

Retrieving and Refiling Records - Public Agencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	n/a	SUDORS Case Report - Retrieving and Refiling Records	Att E. Retrieving and refiling records_1128_SUDORS.pdf		Yes	Yes	Fillable Fileable
Other-Specifications for Data items to be Abstracted			Att D SUDORS_Data_Elements_8_31_cl.docx		No		Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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	65,676	32,576	33,100
Annual IC Time Burden (Hours)	32,838	16,288	16,550
Annual IC Cost Burden (Dollars)	897,791	897,791	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screen Shots for SUDORS	Att F1 1128_SUDORS_screen_Shots_8_31_cl.docx	10/25/2019

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