Information Collection

N-ssats Bc

IC 191116 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 Betwe N-SSATS BC	Form and Instruction
N-SSATS 2021 Betwe N-SSATS 2021 Between Cycles N-SSATS Attachment B3_as of 2020-02-26_N-SSATS 2021 Between Cycles N-SSATS (N-SSATS BC).DOCX	Form and Instruction
Attachment B12- Between Cycles N-SSATS advance letter.pdf Between Cycles N-SSATS Advance Letter	IC Document
Attachment B14_as of 2020-02-26_N-SSATS 2021 Between Cycles N-SSATS (N-SSATS BC) Advance Letter.docx N-SSATS 2021 Between Cycles Advance Letter	IC Document

IC Title:

N-SSATS BC

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N-SSATS 2021 Between Cycles N-SSATS	N-SSATS 2021 Between Cycles N-SSATS	Attachment B3_as of 2020-02-26_N-SSATS 2021 Between Cycles N-SSATS (N-SSATS BC).DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	580	580
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Between Cycles N-SSATS Advance Letter	Attachment B12- Between Cycles N-SSATS advance letter.pdf	10/12/2018
N-SSATS 2021 Between Cycles Advance Letter	Attachment B14_as of 2020-02-26_N-SSATS 2021 Between Cycles N-SSATS (N-SSATS BC) Advance Letter.docx	06/04/2020

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