Information Collection

TB Indicator Reporting Form

IC 218237 under ICR 202108-0920-011 · OMB 0920-1102.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1102 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TB Indicator Reporting Form	Form
TB Indicator Data Reporting Form Attachment C TB Indicator Reporting Form_2021.pdf	Form
TB Indicator Data Reporting Form Attachment C TB Indicator Reporting Form_2021.pdf	Form

IC Title:

TB Indicator Reporting Form

Agency IC Tracking Number:

0920-1102

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
Form	none	TB Indicator Data Reporting Form	Attachment C TB Indicator Reporting Form_2021.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 333

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	333	-3	336
Annual IC Time Burden (Hours)	999	-9	1,008
Annual IC Cost Burden (Dollars)	105,115	656	104,459

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.