Information Collection

Annual Progress Report Instrument

IC 184866 under ICR 202009-0920-006 · OMB 0920-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Annual Progress Report Instrument	Form and Instruction
Annual Progress Report Instruments Att F_Annual Progress Report Instruments_081420.docx	Form and Instruction
Annual Progress Report Instruments Att F_Annual Progress Report Instruments_081420.docx	Form and Instruction

IC Title:

Annual Progress Report Instrument

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Annual Progress Report Instruments	Att F_Annual Progress Report Instruments_081420.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

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	Previously Approved
Annual Number of Responses for this IC	61	0	61
Annual IC Time Burden (Hours)	671	-244	915
Annual IC Cost Burden (Dollars)	231,227	231,227	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.