Information Collection

CoC Applicants- State/local

IC 224158 under ICR 201912-0925-001 · OMB 0925-0689.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0689 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 CoC Applicants- State/local	Form and Instruction
1 OEP CoC Application OEP_CoC Application Screens_11.2.16.pdf	Form and Instruction

IC Title:

CoC Applicants- State/local

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	1	OEP CoC Application	OEP_CoC Application Screens_11.2.16.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service,

FR Citation: 67 FR 60742

Number of Respondents: 650

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-650	650
Annual IC Time Burden (Hours)	-975	975
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.