Information Collection

ABLES Case Records Form

IC 231453 under ICR 202405-0920-005 · OMB 0920-0931.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0931 ABLES Case Records Form	Form and Instruction
0920-0931 ABLES Case Records Form Att6a ABLES Case Rcrds Frm_20231026.xlsx	Form and Instruction
0920-0931 ABLES Case Records Form Att6a ABLES Case Rcrds Frm_20231026.xlsx	Form and Instruction
Att6a1 ABLES Stnd Var_RTsai_20210219.docx ABLES Standardized Varible Formats	IC Document
Att6a1 ABLES Stnd Var_RTsai_20210219.docx ABLES Standardized Varible Formats	IC Document

IC Title:

Agency IC Tracking Number:

0920-0931

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	0920-0931	ABLES Case Records Form	Att6a ABLES Case Rcrds Frm_20231026.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 âEpidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 32

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
	Approved	Previously Approved
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ABLES Standardized Varible Formats	Att6a1 ABLES Stnd Var_RTsai_20210219.docx	03/12/2021

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