Information Collection

Data Collection Checklist

IC 185554 under ICR 202312-0920-008 · OMB 0920-0621.

Documents and Forms

Document Name Document Type
Form 0920-0621 Data Collection Checklist Form and Instruction
0920-0621 Class Participation Form 0621 NYTS Att I4 Class Participation Form final.docx Form and Instruction
Class Participation Form 0621 NYTS Att I4 Class Participation Form final.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Collection Checklist	Agency IC Tracking Number:	0920-0621

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Class Participation Form	0621 NYTS Att I4 Class Participation Form final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,497	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,497	320	1,177
Annual IC Time Burden (Hours)	374	79	295
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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