Information Collection

Performance Data: Quarterly Report Template

IC 234241 under ICR 202208-0990-003 · OMB 0990-0275.

Documents and Forms

Document Name Document Type
0990-0275 Copy of Performance Data Reporting_Template w PRA Language.xlsx Other-report
0990-0275 Copy of Performance Data Reporting_Template w PRA Language.xlsx Other-report

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Performance Data: Quarterly Report Template	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-report			0990-0275 Copy of Performance Data Reporting_Template w PRA Language.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	-120	520
Annual IC Time Burden (Hours)	300	-90	390
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].