Information Collection

2019-2024 PRC-PERS Questions

IC 248335 under ICR 202107-0920-005 · OMB 0920-1358.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment5_PERS_ListofQuestions.pdf	Other-Web
Attachment5_PERS_ListofQuestions.pdf	Other-Web
Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx Att 6_PRC Program Webbased	IC Document
Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx Att 6_PRC Program Webbased	IC Document

IC Title:

Agency IC Tracking Number:

0920-21BG

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
Other-Web			Attachment5_PERS_ListofQuestions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 6_PRC Program Webbased	Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx	07/12/2021

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