Information Collection

[PHIC] 2025 LLS Host Site Survey

IC 274473 under ICR 202411-0920-004 · OMB 0920-1163.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1163 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0006 Att_1_2025 LLS Sup Surv [PHIC] 2025 LLS Host Site Survey	Form
Form 0920-25-0006 Att_5_2025 LLS Sup ExSurv [PHIC] 2025 LLS Host Site Survey	Form
0920-25-0006 Att_1_2025 LLS Sup Surv Att_1_2025 LLS Sup Surv.docx	Form
0920-25-0006 Att_5_2025 LLS Sup ExSurv Att_5_2025 LLS Sup ExSurv rev.docx	Form
Att_2_2025 LLS Sup Surv_Scr.docx Att_2_2025 LLS Sup Surv_Scr	IC Document
Att_3_2025 LLS Sup Surv_InvEmail.docx Att_3_2025 LLS Sup Surv_InvEmail	IC Document
Att_4_2025 LLS Sup Surv RemEmail.docx Att_4_2025 LLS Sup Surv RemEmail	IC Document
Att_6_2025 LLS Sup ExSurv_Scr.docx Att_6_2025 LLS Sup ExSurv_Scr	IC Document
Att_7_2025 LLS Sup ExSurv_InvEm.docx Att_7_2025 LLS Sup ExSurv_InvEm	IC Document
Att_8_2025 LLS Sup ExSurv_RemEm.docx Att_8_2025 LLS Sup ExSurv_RemEm	IC Document
GenIC_Survey_LLS.docx GenIC Request	IC Document

IC Title:

[PHIC] 2025 LLS Host Site Survey

Agency IC Tracking Number:

0920-25-0006

IC Status: New

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	0920-25-0006				Yes	Yes	Fillable Fileable
Form	0920-25-0006				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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