Information Collection

Attachment D_Additional Data Elements

IC 261604 under ICR 202502-0915-001 · OMB 0915-0298.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0298 can be found here:

Documents and Forms

Document Name Document Type
Form 3_revised Attachment D_Additional Data Elements Form and Instruction
Form 3_revised Attachment D_Additional Data Elements Form and Instruction
3_revised 0915-0298_MCHB_Additional Data Elements_Redline_02242025 0915-0298_MCHB_Additional Data Elements_Redline_02242025.docx Form and Instruction
3_revised 0915-0298_MCHB_Additional Data Elements_Redline_02242025 0915-0298_MCHB_Additional Data Elements_Redline_02242025.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment D_Additional Data Elements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3_revised	0915-0298_MCHB_Additional Data Elements_Redline_02242025	0915-0298_MCHB_Additional Data Elements_Redline_02242025.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 578	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	578	578
Annual IC Time Burden (Hours)	1,463	1,463
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.