Information Collection

State Survey

IC 232037 under ICR 202107-0910-013 · OMB 0910-0855.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0855 can be found here:

Documents and Forms

Document Name Document Type
0855 Appendix A NAFDS Survey June 9 2021.docx Other-Survey Invitation; Appendix A
0855 Appendix A NAFDS Survey June 9 2021.docx Other-Survey Invitation; Appendix A

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Survey	Agency IC Tracking Number:	CFSAN

Is this a Common Form? No		IC Status: Modified

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
Other-Survey Invitation; Appendix A			0855 Appendix A NAFDS Survey June 9 2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	451	49
Annual IC Time Burden (Hours)	165	149	16
Annual IC Cost Burden (Dollars)	0	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.