Information Collection

Tick Services Assessment

IC 255964 under ICR 202209-0920-009 · OMB 0920-1386.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Tick Services Assessment	Form and Instruction
Tick Services Assessment Att 3 Survey Codebook.pdf	Form and Instruction
Tick Services Assessment Att 3 Survey Codebook.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-22FC

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Tick Services Assessment	Att 3 Survey Codebook.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
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.