Information Collection

N-sumhss Bc

IC 243267 under ICR 202311-0930-001 · OMB 0930-0386.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form N-SUMHSS Between C N-SUMHSS BC	Form and Instruction
N-SUMHSS Between C N-SUMHSS Between Cycle Questionnaire Attachment B. N-SUMHSS Between Cycle Questionnaire final _202308.pdf	Form and Instruction
N-SUMHSS Between C N-SUMHSS Between Cycle Questionnaire Attachment B. N-SUMHSS Between Cycle Questionnaire final _202308.pdf	Form and Instruction
Attachment B1. N-SUMHSS Between Cycle Questionnaire - Track Changes final _202308.docx N-SUMHSS Between Cycle Questionnaire - Tracked	IC Document
Attachment B1. N-SUMHSS Between Cycle Questionnaire - Track Changes final _202308.docx N-SUMHSS Between Cycle Questionnaire - Tracked	IC Document

IC Title:

N-SUMHSS BC

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	N-SUMHSS Between Cycle Questionnaire	N-SUMHSS Between Cycle Questionnaire	Attachment B. N-SUMHSS Between Cycle Questionnaire final _202308.pdf		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	500	1,000
Annual IC Time Burden (Hours)	1,125	545	580
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
N-SUMHSS Between Cycle Questionnaire - Tracked	Attachment B1. N-SUMHSS Between Cycle Questionnaire - Track Changes final _202308.docx	11/30/2023

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