Information Collection

VDSCP Enrollment Section on Data Submission Form (LDT)

IC 255904 under ICR 202209-0920-008 · OMB 0920-1389.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1389 can be found here:

Documents and Forms

Document Name Document Type
VDSCP Enrollment Section on Data Submission Form (LDT) Form
VDSCP Enrollment Section on Data Submission Form Att 3e. VDSCPEnroll&DataReturn.pdf Form
VDSCP Enrollment Section on Data Submission Form Att 3e. VDSCPEnroll&DataReturn.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VDSCP Enrollment Section on Data Submission Form (LDT)	Agency IC Tracking Number:	0920-22AW

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	n/a	VDSCP Enrollment Section on Data Submission Form	Att 3e. VDSCPEnroll&DataReturn.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
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.