Information Collection

N-ssats

IC 191114 under ICR 202006-0930-001 · OMB 0930-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form N-SSATS 2021 Quest N-SSATS	Form and Instruction
N-SSATS 2021 Quest N-SSATS 2021 Questionnaire (Version A) Attachment B1_as of 2020-02-26_N-SSATS 2021 Questionnaire (Version A).DOCX	Form and Instruction
N-SSATS 2022 Quest N-SSATS 2022 Questionnaire (Version B) Attachment B2_as of 2020-02-26_N-SSATS 2022 Questionnaire (Version B).DOCX	Form and Instruction
N-SSATS 2021 Scree N-SSATS 2021 Screens for Online Questionnaire Attachment B4_as of 2020-02-26_N-SSATS 2021 screens for online questionnaire.docx	Form and Instruction
N-SSATS 2021 CATI N-SSATS 2021 CATI Questionnaire Attachment B5_as of 2020-02-26_N-SSATS 2021 CATI Questionnaire.docx	Form and Instruction
Attachment B6_as of 2020-02-26_N-SSATS 2021 Advance Letter.docx N-SSATS 2021 Advance Letter	IC Document
Attachment B11_as of 2020-02-26_N-SSATS 2021 Second Mailing Cover Letter.docx N-SSATS 2021 Second Mailing Cover Letter	IC Document
Attachment B12_as of 2020-02-26_N-SSATS 2021 Third Mailing Cover Letter.DOCX N-SSATS 2021 Third Mailing Cover Letter	IC Document
Attachment B10_as of 2020-02-26_N-SSATS 2021 Thank You Reminder Letter.docx N-SSATS 2021 Thank You Reminder Letter	IC Document
Attachment B13_as of 2020-02-26_N-SSATS 2021 Completion Thank You Letter.DOCX N-SSATS 2021 Completion Thank You Letter	IC Document
Attachment B15_as of 2020-02-26_Web pages for the 2021 N-SSATS information website.pdf Webpages for the N-SSATS 2021 Information website	IC Document
Attachment B7_as of 2020-02-26_N-SSATS 2021 First Mailing Cover Letter.docx N-SSATS 2021 First Mailing Cover Letter	IC Document
Attachment B8_as of 2020-02-26_N-SSATS 2021 Online Questionnaire Access Instructions.docx N-SSATS 2021 Online Questionnaire Access Instructions	IC Document
Attachment B9_as of 2020-02-26_N-SSATS 2021 Frequently Asked Questions sheet.docx N-SSATS 2021 Frequently Asked Questions	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

N-SSATS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N-SSATS 2021 Questionnaire (Version A)	N-SSATS 2021 Questionnaire (Version A)	Attachment B1_as of 2020-02-26_N-SSATS 2021 Questionnaire (Version A).DOCX	Yes	Yes	Fillable Fileable
Form and Instruction	N-SSATS 2022 Questionnaire (Version B)	N-SSATS 2022 Questionnaire (Version B)	Attachment B2_as of 2020-02-26_N-SSATS 2022 Questionnaire (Version B).DOCX	Yes	Yes	Fillable Fileable
Form and Instruction	N-SSATS 2021 Screens for Online Questionnaire	N-SSATS 2021 Screens for Online Questionnaire	Attachment B4_as of 2020-02-26_N-SSATS 2021 screens for online questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N-SSATS 2021 CATI Questionnaire	N-SSATS 2021 CATI Questionnaire	Attachment B5_as of 2020-02-26_N-SSATS 2021 CATI Questionnaire.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17,000

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	Previously Approved
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	11,333	11,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
N-SSATS 2021 Advance Letter	Attachment B6_as of 2020-02-26_N-SSATS 2021 Advance Letter.docx	06/04/2020
N-SSATS 2021 Second Mailing Cover Letter	Attachment B11_as of 2020-02-26_N-SSATS 2021 Second Mailing Cover Letter.docx	06/04/2020
N-SSATS 2021 Third Mailing Cover Letter	Attachment B12_as of 2020-02-26_N-SSATS 2021 Third Mailing Cover Letter.DOCX	06/04/2020
N-SSATS 2021 Thank You Reminder Letter	Attachment B10_as of 2020-02-26_N-SSATS 2021 Thank You Reminder Letter.docx	06/04/2020
N-SSATS 2021 Completion Thank You Letter	Attachment B13_as of 2020-02-26_N-SSATS 2021 Completion Thank You Letter.DOCX	06/04/2020
Webpages for the N-SSATS 2021 Information website	Attachment B15_as of 2020-02-26_Web pages for the 2021 N-SSATS information website.pdf	06/04/2020
N-SSATS 2021 First Mailing Cover Letter	Attachment B7_as of 2020-02-26_N-SSATS 2021 First Mailing Cover Letter.docx	06/04/2020
N-SSATS 2021 Online Questionnaire Access Instructions	Attachment B8_as of 2020-02-26_N-SSATS 2021 Online Questionnaire Access Instructions.docx	06/04/2020
N-SSATS 2021 Frequently Asked Questions	Attachment B9_as of 2020-02-26_N-SSATS 2021 Frequently Asked Questions sheet.docx	06/04/2020

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