Information Collection

Dog Permit Application Form

IC 253387 under ICR 202301-0920-010 · OMB 0920-1383.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1383 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22BY Dog Permit Application Form	Form and Instruction
Form 0920-22BY Dog Permit Application Form	Form and Instruction
0920-22BY Dog Permit Application Form Attachment C_Dog Permit Application Form.docx	Form and Instruction
0920-22BY Dog Permit Application Form Attachment C_Dog Permit Application Form.docx	Form and Instruction
0920-1383 CDC RABIES VACCINATION AND MICROCHIP RECORD Standard rabies vaccination certificate form_0920-1383.docx	Form and Instruction
0920-1383 CDC RABIES VACCINATION AND MICROCHIP RECORD Standard rabies vaccination certificate form_0920-1383.docx	Form and Instruction

IC Title:

Dog Permit Application Form

Agency IC Tracking Number:

0920-22BY

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-22BY	Dog Permit Application Form	Attachment C_Dog Permit Application Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1383	CDC RABIES VACCINATION AND MICROCHIP RECORD	Standard rabies vaccination certificate form_0920-1383.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities

FR Citation: 83 FR 6591

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	60,000	60,000
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.