Information Collection

Mosquito and Tick Control Program Questionnaire

IC 260277 under ICR 202305-0920-007 · OMB 0920-1409.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Mosquito and Tick Control Program Questionnaire	Form and Instruction
Mosquito and Tick Control Program Questionnaire Attachment 1 -Mosquito and Tick Control Program Questionnaire Word Version.docx	Form and Instruction
Mosquito and Tick Control Program Questionnaire Attachment 1 -Mosquito and Tick Control Program Questionnaire Word Version.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-23CA

Is this a Common Form? No

IC Status: New

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	n/a	Mosquito and Tick Control Program Questionnaire	Attachment 1 -Mosquito and Tick Control Program Questionnaire Word Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,109

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
Annual Number of Responses for this IC	1,109	1,109
Annual IC Time Burden (Hours)	167	167
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.