Information Collection

MDPS Study Facilities Burden

IC 252414 under ICR 202203-0930-004 · OMB 0930-0388.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
No Instrument.docx	Other-
No Instrument.docx	Other-

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-			No Instrument.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: MDPS Study

FR Citation: 75 FR 28264

Number of Respondents: 638

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	638	638
Annual IC Time Burden (Hours)	1,146	1,146
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.