Information Collection

Component 1 Reporting Template

IC 244060 under ICR 202402-0920-013 · OMB 0920-1329.

Documents and Forms

Document Name Document Type
Form 0920-1329 Component 1 Reporting Template Form and Instruction
0920-1329 PS18-1807 Component 1 Surveillance Reporting Template -W Att 3_Component 1 Reporting Template (1-31-20).docx Form and Instruction
0920-1329 PS18-1807 Component 1 Surveillance Reporting Template -W Att 3_Component 1 Reporting Template (1-31-20).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Component 1 Reporting Template	Agency IC Tracking Number:	0920-1329

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1329	PS18-1807 Component 1 Surveillance Reporting Template -Work Plan Status Report	Att 3_Component 1 Reporting Template (1-31-20).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	-80	240
Annual IC Time Burden (Hours)	1,280	-640	1,920
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.