Information Collection

SPF-Rx Supplemental

IC 227195 under ICR 202109-0930-002 · OMB 0930-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0354 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SPF-RX SPF-Rx Supplemental	Form and Instruction
SPF-RX SPF-RX DSP MRT Attachment _4 SPF-Rx _No changes.docx	Form and Instruction
SPF-RX SPF-RX DSP MRT Attachment _4 SPF-Rx _No changes.docx	Form and Instruction

IC Title:

SPF-Rx Supplemental

Agency IC Tracking Number:

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 and Instruction	SPF-RX	SPF-RX	DSP MRT Attachment _4 SPF-Rx _No changes.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: SPF-RX

FR Citation: 75 FR 28264

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	104	4	100
Annual IC Time Burden (Hours)	104	4	100
Annual IC Cost Burden (Dollars)	0	0	0

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.