Information Collection

[OPHDST] MVPS CaseBridge

IC 272207 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A_CaseBridge.docx	Instruction
Appendix A_CaseBridge.docx	Instruction
0920-1050 MVPS_CaseBridge.docx Change Request	IC Document
0920-1050 MVPS_CaseBridge.docx Change Request	IC Document
SSA_CaseBridge.docx SSA	IC Document
SSA_CaseBridge.docx SSA	IC Document

IC Title:

[OPHDST] MVPS CaseBridge

Agency IC Tracking Number:

0920-1050-25AX

IC Status: Unchanged

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
Instruction					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

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
	Requested	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	192	192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Change Request		11/06/2024
SSA		11/06/2024

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

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