Component 3: Special Projects

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1353 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-21EE Component 3: Special Projects Form
0920-21EE 3c_Component 3 Comp 3_APR_Form_Year2_12-08-2021_Aug2022_clean.docx Form
0920-21EE 3c_Component 3 Comp 3_APR_Form_Year2_12-08-2021_Aug2022_clean.docx Form
Att 4c_Comp 3 instructions_11-5-2021.docx Att 4c_Comp 3 instructions_11-5-2021 IC Document
Att 4c_Comp 3 instructions_11-5-2021.docx Att 4c_Comp 3 instructions_11-5-2021 IC Document

Information Collection (IC) Details

IC Title:	Component 3: Special Projects	Agency IC Tracking Number:	0920-22AV

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-21EE	3c_Component 3	Comp 3_APR_Form_Year2_12-08-2021_Aug2022_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4c_Comp 3 instructions_11-5-2021	Att 4c_Comp 3 instructions_11-5-2021.docx	11/18/2021

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