DSP-MRT Standard Tool

Division of State Programs—Management Reporting Tool (DSP-MRT)

Documents and Forms

Document Name Document Type
Form DSP-MRT Standard T DSP-MRT Standard Tool Form and Instruction
DSP-MRT Standard T DSP-MRT Standard Tool DSP-MRT Attachment _1 Revised 4-23-21.docx Form and Instruction
DSP-MRT Standard T DSP-MRT Standard Tool DSP-MRT Attachment _1 Revised 4-23-21.docx Form and Instruction

Information Collection (IC) Details

IC Title:	DSP-MRT Standard Tool	Agency IC Tracking Number:

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
Form and Instruction	DSP-MRT Standard Tool	DSP-MRT Standard Tool	DSP-MRT Attachment _1 Revised 4-23-21.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: DSP-MRT Standard Tool	FR Citation: 75 FR 28264

Number of Respondents: 521	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,084	1,616	468
Annual IC Time Burden (Hours)	6,252	4,848	1,404
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.