Information Collection

HHSAR 337.103(d)(4)

IC 217364 under ICR 202111-0990-006 · OMB 0990-0433.

Documents and Forms

Document Name Document Type
0990-0433 OF306AddendumToDeclarationForFederalEmployment.pdf Other-instruments

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HHSAR 337.103(d)(4)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-instruments			0990-0433 OF306AddendumToDeclarationForFederalEmployment.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	1,840	160
Annual IC Time Burden (Hours)	67	-93	160
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.