Information Collection

42 Cfr 2.31; 2.52; 2.53

IC 242313 under ICR 202301-0930-005 · OMB 0930-0092.

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IC Title:

42 CFR 2.31; 2.52; 2.53

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 2.31 Consent Requirements 42 CFR 2.52 Research 42 CFR 2.53 Audit and Evaluation

Information Collection Instruments:

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,585

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	248,741	248,741
Annual IC Time Burden (Hours)	155,463	155,463
Annual IC Cost Burden (Dollars)	6,964,748	6,964,748

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.