Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)

Maritime Illness Database and Reporting System (MIDRS)

Documents and Forms

Document Name Document Type
Form 092-1260 Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax) Form and Instruction
092-1260 Special Reports exceeding 2%-3% AGE Threshold (web/phone Att5a3 SpecialReprts 2%-3% AGE Threshold (non-standard) 20220125.docx Form and Instruction
092-1260 Special Reports exceeding 2%-3% AGE Threshold (web/phone Att5a3 SpecialReprts 2%-3% AGE Threshold (non-standard) 20220125.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Agency IC Tracking Number:	0920-1260

Is this a Common Form? No		IC Status: New

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 and Instruction	092-1260	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Att5a3 SpecialReprts 2%-3% AGE Threshold (non-standard) 20220125.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	720	720
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	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.