Information Collection

SDY Module N for State Health Personnel

IC 234894 under ICR 202201-0920-011 · OMB 0920-1092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1092 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1092 SDY Module N for State Health Personnel Form
0920-1092 N SUID AND SDY CASE REGISTRY Att 2c_NFR-CRS-SDY Module N.pdf Form
0920-1092 N SUID AND SDY CASE REGISTRY Att 2c_NFR-CRS-SDY Module N.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SDY Module N for State Health Personnel	Agency IC Tracking Number:	0920-1092

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
Form	0920-1092	N SUID AND SDY CASE REGISTRY	Att 2c_NFR-CRS-SDY Module N.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	715	-27	742
Annual IC Time Burden (Hours)	119	-5	124
Annual IC Cost Burden (Dollars)	2,252	-85	2,337

Documents for IC

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.