Information Collection

Retrieving and Refiling Records - Data Elements

IC 227708 under ICR 202503-0920-032 · OMB 0920-1128.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1128 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Retrieving and Refiling Records - Data Elements	Form and Instruction
SUDORS Case Report - Retrieving and Refiling Records Retrieving and Refiling Records - Data Elements	Form and Instruction
Form 0920-25-0063 SUDORS Retrieving and Refiling Records - Data Elements	Form
SUDORS Case Report - Retrieving and Refiling Records Att D SUDORS_Data_Elements.docx	Form and Instruction
SUDORS Case Report - Retrieving and Refiling Records Att D SUDORS_Data_Elements.docx	Form and Instruction
0920-25-0063 SUDORS SUDORS AFTER screenshot.docx	Form
0920-25-0063 SUDORS SUDORS AFTER screenshot.docx	Form
Att E. SUDORS_Data_Elements_ Screen Shots.docx Screen Shots for SUDORS Data Elements	IC Document
Att E. SUDORS_Data_Elements_ Screen Shots.docx Screen Shots for SUDORS Data Elements	IC Document

IC Title:

Retrieving and Refiling Records - Data Elements

Agency IC Tracking Number:

0920-1128

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	n/a				Yes	Yes	Fillable Fileable
Form	0920-25-0063				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

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	Previously Approved
Annual Number of Responses for this IC	87,261	87,261
Annual IC Time Burden (Hours)	43,631	43,631
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screen Shots for SUDORS Data Elements		09/07/2022

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

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