Information Collection

CQM Group Discussion

IC 241425 under ICR 202110-0920-012 · OMB 0920-1311.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CQM Group Discussion	Form and Instruction
CQM Health Department Group Discussion Guide Att 4b. CQM HD Group Disc Guide_rev.docx	Form and Instruction
CQM Health Department Group Discussion Guide Att 4b. CQM HD Group Disc Guide_rev.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	n/a	CQM Health Department Group Discussion Guide	Att 4b. CQM HD Group Disc Guide_rev.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 27

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	2,376	2,376

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.