Information Collection

Permission Form Checklist

IC 244895 under ICR 202012-0920-007 · OMB 0920-1334.

Documents and Forms

Document Name Document Type
Form 0920- Permission Form Checklist Form
0920- Permission Form Checklist Att N-Permission Form Checklist.docx Form
0920- Permission Form Checklist Att N-Permission Form Checklist.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Permission Form Checklist	Agency IC Tracking Number:	0920-20OJ

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-	Permission Form Checklist	Att N-Permission Form Checklist.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.