Information Collection

Minimum Data Elements (MDE) Data Definition Table

IC 250030 under ICR 202111-0920-005 · OMB 0920-1046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1046 Minimum Data Elements (MDE) Data Definition Table	Form and Instruction
0920-1046 Minimum Data Elements (MDE) Data Definition Table Att 9 - MDE Data Definitions.pdf	Form and Instruction
0920-1046 Minimum Data Elements (MDE) Data Definition Table Att 9 - MDE Data Definitions.pdf	Form and Instruction

IC Title:

Minimum Data Elements (MDE) Data Definition Table

Agency IC Tracking Number:

0920-1046

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1046	Minimum Data Elements (MDE) Data Definition Table	Att 9 - MDE Data Definitions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

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
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	350	350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.