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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[OPHDST] MVPS CaseBridge	Agency IC Tracking Number:	0920-1050-25AX

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix A_CaseBridge.docx		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 %

	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

Title	Document	Date Uploaded
Change Request	0920-1050 MVPS_CaseBridge.docx	11/06/2024
SSA	SSA_CaseBridge.docx	11/06/2024

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