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

[NCCHSTP] Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Documents and Forms

Document Name Document Type
Form 0920-1353 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

Information Collection (IC) Details

IC Title:	Att 3a_Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities	Agency IC Tracking Number:	0920-1353

Is this a Common Form? Yes		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	0920-1353	Component 1: Core Viral Hepatitis Outbreak Response and Surveillance Activities	Att 3a_Component 1_11-5-2021.docx		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 %

	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

Title	Document	Date Uploaded
Annual Performance Report—Component 1--Form Instructions Year 3 Reporting Period (10/1/22-9/30/23)	Att5a _Comp 1 Instructions.docx	03/22/2024

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