Information Collection

RECORDKEEPING: Public Health Authorities

IC 236302 under ICR 202207-0910-004 · OMB 0910-0595.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0595 can be found here:

Documents and Forms

IC Title:

Agency IC Tracking Number:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Guidance	0595_Guidance_2019.pdf	Yes	No	Fillable Printable
Other-Statutory Authority	21 USC 360bbb-3 FFDCA Section 564.pdf	Yes	Yes	Fillable Fileable
Other-Statutory Authority	21 USC 360bbb-3a FFDCA Section 564A.pdf	Yes	Yes	Fillable Fileable
Other-Statutory Authority	21 USC 360bbb-3b FFDCA Section 564B.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	2	2
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.