Information Collection

Core Viral Hepatitis Outbreak Prevention Activities

IC 248657 under ICR 202111-0920-016 · OMB 0920-1353.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1353 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22AV Core Viral Hepatitis Outbreak Prevention Activities	Form
0920-22AV Att 3b_Component 2_11-5-2021 Att 3b_Component 2_11-5-2021.docx	Form
0920-22AV Att 3b_Component 2_11-5-2021 Att 3b_Component 2_11-5-2021.docx	Form
Att 4b_Comp 2 instructions_11-5-2021.docx Att 4b_Comp 2 instructions_11-5-2021	IC Document
Att 4b_Comp 2 instructions_11-5-2021.docx Att 4b_Comp 2 instructions_11-5-2021	IC Document

IC Title:

Core Viral Hepatitis Outbreak Prevention Activities

Agency IC Tracking Number:

0920-22AV

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-22AV	Att 3b_Component 2_11-5-2021	Att 3b_Component 2_11-5-2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

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	59	59
Annual IC Time Burden (Hours)	59	59
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4b_Comp 2 instructions_11-5-2021	Att 4b_Comp 2 instructions_11-5-2021.docx	11/18/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.