Information Collection

Annual Comprehensive Self-Assessment

IC 227346 under ICR 202303-0583-002 · OMB 0583-0170.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
At_Least_Equal_to_Guidelines November 2016.pdf	Other-guidance
At_Least_Equal_to_Guidelines November 2016.pdf	Other-guidance

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-guidance			At_Least_Equal_to_Guidelines November 2016.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 27

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-27	27
Annual IC Time Burden (Hours)	-5,049	5,049
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.