PAsS Data Submission Form

NCEH DLS Laboratory Quality Assurance Programs

Documents and Forms

Document Name Document Type
PAsS Data Submission Form Form
PAsS Data Submission Form Att 3j-I. PAsS Data Return Form.pdf Form
PAsS Data Submission Form Att 3j-I. PAsS Data Return Form.pdf Form

Information Collection (IC) Details

IC Title:	PAsS Data Submission Form	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	PAsS Data Submission Form	Att 3j-I. PAsS Data Return Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	112	112
Annual IC Time Burden (Hours)	19	19
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.