Information Collection

Nehrs

IC 238511 under ICR 201911-0920-005 · OMB 0920-1015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1015 NEHRS	Form and Instruction
0920-1015 NEHRS Att_C1_-_2019_Instrument[1].pdf	Form and Instruction

IC Title:

NEHRS

Agency IC Tracking Number:

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	0920-1015	NEHRS	Att_C1_-_2019_Instrument[1].pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: NEHRS

FR Citation: 84 FR 38986

Number of Respondents: 10,302

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	10,302	10,302
Annual IC Time Burden (Hours)	5,151	5,151
Annual IC Cost Burden (Dollars)	0	0

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.