Information Collection

Annual evaluation and Performance Measurement Report (Candida)

IC 239437 under ICR 202302-0920-008 · OMB 0920-1310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 5 Annual evaluation and Performance Measurement Report (Candida)	Form and Instruction
Form 5 Annual Eval and Performance Measurement Report (Candida) Attachment 3e Form 5 Annual Evaluation and Performance Measurement Report (Candida identification) final.docx	Form and Instruction
Form 5 Annual Eval and Performance Measurement Report (Candida) Attachment 3e Form 5 Annual Evaluation and Performance Measurement Report (Candida identification) final.docx	Form and Instruction

IC Title:

Annual evaluation and Performance Measurement Report (Candida)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	Form 5	Annual Eval and Performance Measurement Report (Candida)	Attachment 3e Form 5 Annual Evaluation and Performance Measurement Report (Candida identification) final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	1	55
Annual IC Time Burden (Hours)	112	2	110
Annual IC Cost Burden (Dollars)	0	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.