Information Collection

Investigation Protocol Template

IC 261657 under ICR 202408-0920-013 · OMB 0920-1419.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1419 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Investigation Protocol Template	Form and Instruction
Form 0920- Investigation Protocol Template Investigation Protocol Template	Form and Instruction
0920- Investigation Protocol Template Attachment C Request Protocol_PHPS GenIC_v3.docx	Form and Instruction
0920- Investigation Protocol Template Attachment C Request Protocol_PHPS GenIC_v3.docx	Form and Instruction
Attachment D Burden memo PHPS GenIC_v3.docx Burden Memo	IC Document
Attachment D Burden memo PHPS GenIC_v3.docx Burden Memo	IC Document

IC Title:

Investigation Protocol Template

Agency IC Tracking Number:

0920-23FQ

IC Status: Unchanged

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	0920-				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden Memo		09/05/2023

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

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