Information Collection

Annual Reporting: Standards Evaluation Report (SER)

IC 220109 under ICR 202012-0920-004 · OMB 0920-0573.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0573 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Annual Reporting: Standards Evaluation Report (SER)	Form and Instruction
2021 Standards Evaluation Report (SER) a. SER PS18-1802 OMB Yrs 2-5 Form_2021_v6_clean.docx	Form and Instruction
a. SER PS18-1802 OMB Yrs 2-5 Form_2021_v6_trackchanges.docx Tracked-changes version of the 2021 SER to facilitate review of changes	IC Document

IC Title:

Annual Reporting: Standards Evaluation Report (SER)

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	n/a	2021 Standards Evaluation Report (SER)	a. SER PS18-1802 OMB Yrs 2-5 Form_2021_v6_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC

FR Citation: 57 FR 62812

Number of Respondents: 59

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	59	59
Annual IC Time Burden (Hours)	472	472
Annual IC Cost Burden (Dollars)	12,744	12,744

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tracked-changes version of the 2021 SER to facilitate review of changes	a. SER PS18-1802 OMB Yrs 2-5 Form_2021_v6_trackchanges.docx	12/10/2020

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