Information Collection

I-bhs

IC 243263 under ICR 202008-0930-002 · OMB 0930-0386.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0386 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-BHS Online State I-BHS	Form and Instruction
I-BHS Online State I-BHS Online State Add Update Form Attachment A1 I-BHS Online State Add_Update Forms.pdf	Form and Instruction
I-BHS Online State I-BHS Online State Add Update Form Attachment A1 I-BHS Online State Add_Update Forms.pdf	Form and Instruction

IC Title:

I-BHS

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	I-BHS Online State Add Update Form	I-BHS Online State Add Update Form	Attachment A1 I-BHS Online State Add_Update Forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

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	4,200	4,200
Annual IC Time Burden (Hours)	336	336
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.