Information Collection

Survey Instrument

IC 252358 under ICR 202203-1018-002 · OMB 1018-0184.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Wildlife Health Capacity Assessment Tool Final w-PRA 03242022.docx	Other-Draft Survey Instrument
Wildlife Health Capacity Assessment Tool Final w-PRA 03242022_omb Final 04052022.docx	Other-Draft Survey Instrument

IC Title:

Survey Instrument

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-Draft Survey Instrument			Wildlife Health Capacity Assessment Tool Final w-PRA 03242022_omb Final 04052022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 630

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	630	630
Annual IC Time Burden (Hours)	210	210
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.