Information Collection

Minimum Data Elements (MDE) Data Definition Table

IC 250030 under ICR 202501-0920-002 · OMB 0920-1046.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1046 Minimum Data Elements (MDE) Data Definition Table	Form and Instruction
Form 0920-1046 Minimum Data Elements (MDE) Data Definition Table Minimum Data Elements (MDE) Data Definition Table	Form and Instruction
0920-1046 Minimum Data Elements (MDE) Data Definition Table Att 9 - MDE Data Definitions.pdf	Form and Instruction
0920-1046 Minimum Data Elements (MDE) Data Definition Table Att 9 - MDE Data Definitions.pdf	Form and Instruction
OMB Control Header and Burden Statement.docx OMB Control Header and Burden Statement	IC Document
OMB Control Header and Burden Statement.docx OMB Control Header and Burden Statement	IC Document

IC Title:

Agency IC Tracking Number:

0920-1046

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1046				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 71

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	142	2	140
Annual IC Time Burden (Hours)	355	5	350
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Control Header and Burden Statement		01/13/2025

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

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