Information Collection

Annual Reporting Data Elements

IC 237592 under ICR 202210-0920-001 · OMB 0920-1286.

Documents and Forms

Document Name Document Type
Att_3b_Annual_Reporting_Data_Elements_for_RPE_Screenshots_2023OMB.pdf Other-Screenshots
Att_3b_Annual_Reporting_Data_Elements_for_RPE_Screenshots_2023OMB.pdf Other-Screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Reporting Data Elements	Agency IC Tracking Number:	0920-1286

Is this a Common Form? No		IC Status: Modified

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
Other-Screenshots			Att_3b_Annual_Reporting_Data_Elements_for_RPE_Screenshots_2023OMB.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	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	Previously Approved
Annual Number of Responses for this IC	106	-4	110
Annual IC Time Burden (Hours)	212	-8	220
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.