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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Investigation Protocol Template	Agency IC Tracking Number:	0920-23FQ

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection 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 %

	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

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.