Information Collection

Tick Services Assessment

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tick Services Assessment	Agency IC Tracking Number:	0920-22FC

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 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 %

	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

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.