Information Collection

Surveillance Data Dissemination Plan

IC 238174 under ICR 201910-0920-003 · OMB 0920-1283.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1283 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Surveillance Data Dissemination Plan	Form and Instruction
Surveillance Data Dissemination Plan Att 3d - Surveillance Data Dissemination Plan.docx	Form and Instruction

IC Title:

Surveillance Data Dissemination Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Surveillance Data Dissemination Plan	Att 3d - Surveillance Data Dissemination Plan.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22

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	22	22
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	733	733

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.