Information Collection

I-TF Facility Registration Application Form

IC 243265 under ICR 202311-0930-001 · OMB 0930-0386.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I-TF Facility Regi I-TF Facility Registration Application Form	Form and Instruction
Form I-TF Facility Regi I-TF Facility Registration Application Form I-TF Facility Registration Application Form	Form and Instruction
I-TF Facility Regi I-TF Facility Registration Application Form Attachment F. I-TF Facility Registration Application Form final.pdf	Form and Instruction
I-TF Facility Regi I-TF Facility Registration Application Form Attachment F. I-TF Facility Registration Application Form final.pdf	Form and Instruction
Attachment F1. I-TF Facility Registration Application Form - Track Changes final.pdf Attachment F1. I-TF Facility Registration Application Form - Track Changes	IC Document
Attachment F1. I-TF Facility Registration Application Form - Track Changes final.pdf Attachment F1. I-TF Facility Registration Application Form - Track Changes	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	I-TF Facility Registration Application Form				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

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	Previously Approved
Annual Number of Responses for this IC	1,500	700	800
Annual IC Time Burden (Hours)	120	56	64
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F1. I-TF Facility Registration Application Form - Track Changes		11/30/2023

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

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