Information Collection

Component 2 - STLT Health Dept Sewershed

IC 263100 under ICR 202310-0920-009 · OMB 0920-1422.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf	Other-Web Upload Screenshot
Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf	Other-Web Upload Screenshot
OMB Control Header and Burden Statement.docx OMB Control Header and Burden Statement	IC Document
OMB Control Header and Burden Statement.docx OMB Control Header and Burden Statement	IC Document

IC Title:

Agency IC Tracking Number:

0920-23GL

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
Other-Web Upload Screenshot			Attachment-07_Component-1-2-3_ref-NWSS_DCIPHER_BulkUploadTool_screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

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	1,100	1,100
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Control Header and Burden Statement	OMB Control Header and Burden Statement.docx	10/30/2023

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