Information Collection

Syringe Sales and Service referrals variables

IC 249321 under ICR 202107-0920-011 · OMB 0920-1364.

Documents and Forms

Document Name Document Type
Attachment 8_Syringe sales and service referrals variables.docx Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Syringe Sales and Service referrals variables	Agency IC Tracking Number:	02021DZ

Is this a Common Form? No		IC Status: New

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-WORD			Attachment 8_Syringe sales and service referrals variables.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	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	12	12
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.