Information Collection

Att. 3a_Screenshots of Metrics Database

IC 222048 under ICR 202012-0920-011 · OMB 0920-1161.

Documents and Forms

Document Name Document Type
Att3a_Screenshots of Metrics Database.docx Other-Screenshots
Att3b_Metrics Data Dictionary.docx Att. 3b_ Metrics Data Dictionary IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att. 3a_Screenshots of Metrics Database	Agency IC Tracking Number:	16LL

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots			Att3a_Screenshots of Metrics Database.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 44	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	176	176
Annual IC Time Burden (Hours)	3,168	3,168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att. 3b_ Metrics Data Dictionary	Att3b_Metrics Data Dictionary.docx	02/22/2021

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