Information Collection

Ongoing Transfer of ED3N Data Elements

IC 257072 under ICR 202211-0920-010 · OMB 0920-1391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1391 can be found here:

Documents and Forms

Document Name Document Type
Att3b ED3N Ongoing Transfer Data Elements.docx Other-Specification of Data Elements
Att3b ED3N Ongoing Transfer Data Elements.docx Other-Specification of Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ongoing Transfer of ED3N Data Elements	Agency IC Tracking Number:

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
Other-Specification of Data Elements for Electronic Transfer			Att3b ED3N Ongoing Transfer Data Elements.docx		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
Annual Number of Responses for this IC	19,345	19,345
Annual IC Time Burden (Hours)	322	322
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.