Information Collection

Investigation Protocol Template

IC 261657 under ICR 202308-0920-007 · OMB 0920-1419.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1419 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Investigation Protocol Template	Form and Instruction
0920- Investigation Protocol Template Attachment C Request Protocol_PHPS GenIC_v3.docx	Form and Instruction
0920- Investigation Protocol Template Attachment C Request Protocol_PHPS GenIC_v3.docx	Form and Instruction
Attachment D Burden memo PHPS GenIC_v3.docx Burden Memo	IC Document
Attachment D Burden memo PHPS GenIC_v3.docx Burden Memo	IC Document

IC Title:

Investigation Protocol Template

Agency IC Tracking Number:

0920-23FQ

IC Status: New

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-	Investigation Protocol Template	Attachment C Request Protocol_PHPS GenIC_v3.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden Memo	Attachment D Burden memo PHPS GenIC_v3.docx	09/05/2023

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