Information Collection

Critical Item Survey

IC 245435 under ICR 202101-0920-015 · OMB 0920-1327.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20QJ Critical Item Survey	Form and Instruction
0920-20QJ Critical Item Survey Attachment 8 - Critical item survey.pdf	Form and Instruction
0920-20QJ Critical Item Survey Attachment 8 - Critical item survey.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-20QJ

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	0920-20QJ	Critical Item Survey	Attachment 8 - Critical item survey.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,417

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,417	4,417
Annual IC Time Burden (Hours)	368	368
Annual IC Cost Burden (Dollars)	0	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.