Information Collection

Att 3a_Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities

IC 248655 under ICR 202403-0920-014 · OMB 0920-1353.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1353 Att 3a_Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities	Form
Form 0920-1353 Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities Att 3a_Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities	Form
0920-1353 Component 1: Core Viral Hepatitis Outbreak Response and Att 3a_Component 1_11-5-2021.docx	Form
0920-1353 Component 1: Core Viral Hepatitis Outbreak Response and Att 3a_Component 1_11-5-2021.docx	Form
Att5a _Comp 1 Instructions.docx Annual Performance Report—Component 1--Form Instructions Year 3 Reporting Period (10/1/22-9/30/23)	IC Document
Att5a _Comp 1 Instructions.docx Annual Performance Report—Component 1--Form Instructions Year 3 Reporting Period (10/1/22-9/30/23)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1353

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-1353				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	59	0	59
Annual IC Time Burden (Hours)	69	10	59
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annual Performance ReportâComponent 1--Form Instructions Year 3 Reporting Period (10/1/22-9/30/23)		03/22/2024

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

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