Information Collection

N-sumhss Bc

IC 243267 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⚠️ Notice: This information collection may be referencing outdated material.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 N-SUMHSS 2021 Betw N-SUMHSS BC	Form and Instruction
N-SUMHSS 2021 Betw N-SUMHSS 2021 Between Cycles Questionnaire Attachment B2_N-SUMHSS 2021 BC Questionnaire 060320.docx	Form and Instruction
N-SUMHSS 2021 Betw N-SUMHSS 2021 Between Cycles Questionnaire Attachment B2_N-SUMHSS 2021 BC Questionnaire 060320.docx	Form and Instruction
Attachment B11_N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter.docx N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter	IC Document
Attachment B11_N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter.docx N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter	IC Document

IC Title:

N-SUMHSS BC

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	N-SUMHSS 2021 Between Cycles Questionnaire	N-SUMHSS 2021 Between Cycles Questionnaire	Attachment B2_N-SUMHSS 2021 BC Questionnaire 060320.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	Program Change Due to Agency Discretion
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
N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter	Attachment B11_N-SUMHSS 2021 Between Cycles (N-SUMHSS BC) Advance Letter.docx	08/20/2020

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