Information Collection

NPCR-CSS Standard Data Items Collected

IC 237544 under ICR 202204-0920-010 · OMB 0920-0469.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0469 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0469 Att 3a Data Items Diagnosis Year 1995-2020.pdf	Instruction
0469 Att 3a Data Items Diagnosis Year 1995-2020.pdf	Instruction
0469 Att 9 OMB Burden Statement on NPCR CSS Website.pdf OMB Burden Statement on the NPCR-CSS Website	IC Document
0469 Att 9 OMB Burden Statement on NPCR CSS Website.pdf OMB Burden Statement on the NPCR-CSS Website	IC Document

IC Title:

NPCR-CSS Standard Data Items Collected

Agency IC Tracking Number:

0920-0469

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Instruction			0469 Att 3a Data Items Diagnosis Year 1995-2020.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0160, Records of Subjects in Health Promotion and Education Studies

FR Citation: 51 FR 42484

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	100	0	100
Annual IC Time Burden (Hours)	200	0	200
Annual IC Cost Burden (Dollars)	7,200	7,200	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Burden Statement on the NPCR-CSS Website	0469 Att 9 OMB Burden Statement on NPCR CSS Website.pdf	05/09/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.