Information Collection

Program-Level Instrument

IC 234465 under ICR 202410-0930-002 · OMB 0930-0384.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0384 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SOR TOR Final Tool Program-Level Instrument	Form and Instruction
Form SOR TOR FInal Tool SOR TOR Final Tool Program-Level Instrument	Form and Instruction
SOR TOR Final Tool SOR TOR Final Tool SOR TOR Final Tool.docx	Form and Instruction
SOR TOR FInal Tool SOR TOR Final Tool SOR TOR Final Tool CLEAN 12-2-24.docx	Form and Instruction

IC Title:

Program-Level Instrument

Agency IC Tracking Number:

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	SOR TOR FInal Tool				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Program-Level Instrument

FR Citation: 75 FR 28264

Number of Respondents: 378

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	945	309	636
Annual IC Time Burden (Hours)	274	83	191
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].