Information Collection

Attachment B Central Forms

IC 261600 under ICR 202404-0915-004 · OMB 0915-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Attachment B Central Forms	Form and Instruction
Form 1 Attachment B Central Forms	Form and Instruction
1 Attachment B DGIS OMB DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx	Form and Instruction
1 Attachment B DGIS OMB DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx	Form and Instruction
1_revised DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC (revis DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC.docx	Form and Instruction
1_revised DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC (revis DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC.docx	Form and Instruction

IC Title:

Attachment B Central Forms

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1	Attachment B DGIS OMB	DGIS OMB_SSA_Attachment B_Central Forms_CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1_revised	DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC (revised form)	DGIS OMB_SSA_Attachment B_Central Forms_nonsub_TC.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,642

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,642	6,642
Annual IC Time Burden (Hours)	14,776	14,776
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.