Information Collection

Work Plan Instrument

IC 6636 under ICR 202401-0920-007 · OMB 0920-0106.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0106 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Work Plan Instrument	Form and Instruction
Work plan instruments Att E_Work Plan Instruments (003)-Updated 081420.docx	Form and Instruction
Work plan instruments Att E_Work Plan Instruments (003)-Updated 081420.docx	Form and Instruction
Att I WorkPlanGuidance 1-25-19. PDF_Final.pdf Att I_WorkPlanGuidance	IC Document
Att I WorkPlanGuidance 1-25-19. PDF_Final.pdf Att I_WorkPlanGuidance	IC Document

IC Title:

Work Plan Instrument

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	none	Work plan instruments	Att E_Work Plan Instruments (003)-Updated 081420.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-61	61
Annual IC Time Burden (Hours)	-732	732
Annual IC Cost Burden (Dollars)	-252,247	252,247

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att I_WorkPlanGuidance	Att I WorkPlanGuidance 1-25-19. PDF_Final.pdf	06/27/2019

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