Information Collection

Field Investigation Data Elements

IC 232307 under ICR 202106-0920-018 · OMB 0920-1242.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1242 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3D Field Investigation Data Elements.docx	Other-Data elements

IC Title:

Field Investigation Data Elements

Agency IC Tracking Number:

0920-17BAN

Is this a Common Form? No

IC Status: Modified

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
Other-Data elements			Att 3D Field Investigation Data Elements.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 960

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	960	-120	1,080
Annual IC Time Burden (Hours)	320	-220	540
Annual IC Cost Burden (Dollars)	11,453	-1,431	12,884

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.