Information Collection

Record Abstraction (STD Clinics)

IC 232378 under ICR 202503-0920-019 · OMB 0920-1072.

Documents and Forms

Document Name Document Type
Form 0920-1072 Record Abstraction (STD Clinics) Form and Instruction
0920-1072 SSuN Data Elements Att 5_SSuN Data Elements_Clean.xlsx Form and Instruction
0920-1072 SSuN Data Elements Att 5_SSuN Data Elements_Clean.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Record Abstraction (STD Clinics)	Agency IC Tracking Number:	0920-1072

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1072	SSuN Data Elements	Att 5_SSuN Data Elements_Clean.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	960	960
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.