Information Collection

PDO/FR CARA Supplemental

IC 227196 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⚠️ Notice: This information collection may be referencing outdated material.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 PDO/FR CARA Supple PDO/FR CARA Supplemental	Form and Instruction
PDO/FR CARA Supple PDO/FR CARA Supplemental DSP MRT Attachment _3 PDOFRCARA Revised.docx	Form and Instruction
PDO/FR CARA Supple PDO/FR CARA Supplemental DSP MRT Attachment _3 PDOFRCARA Revised.docx	Form and Instruction

IC Title:

PDO/FR CARA 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	PDO/FR CARA Supplemental	PDO/FR CARA Supplemental	DSP MRT Attachment _3 PDOFRCARA Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: PDO/FR CARA Supplemental

FR Citation: 75 FR 28264

Number of Respondents: 109

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	218	149	69
Annual IC Time Burden (Hours)	218	149	69
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.