OMB
.report
Search
SDY Module N for State Health Personnel
Sudden Death in the Young Registry
OMB: 0920-1092
IC ID: 234894
OMB.report
HHS/CDC
OMB 0920-1092
ICR 202201-0920-011
IC 234894
( )
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
715
0
-27
0
0
742
Annual IC Time Burden (Hours)
119
0
-5
0
0
124
Annual IC Cost Burden (Dollars)
2,252
0
-85
0
0
2,337
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.