Information Collection

Work Plan Program Questions

IC 264759 under ICR 202506-0920-003 · OMB 0920-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Work Plan Program Questions	Form and Instruction
Workplan Program Quesions Work Plan Program Questions	Form and Instruction
Form 0920-0106 WorkPlan Program Questions_REVISED 31MAR2025 Work Plan Program Questions	Form and Instruction
Workplan Program Quesions Att E_Workplan Program Questions (Word Version).docx	Form and Instruction
Workplan Program Quesions Att E_Workplan Program Questions (Word Version).docx	Form and Instruction
0920-0106 WorkPlan Program Questions_REVISED 31MAR2025 Att E_Workplan Program Qs_clean.docx	Form and Instruction
0920-0106 WorkPlan Program Questions_REVISED 31MAR2025 Att E_Workplan Program Qs_clean.docx	Form and Instruction
Att F_Workplan Program Questions Screenshots_final.docx Workplan Program Quesions (screenshot)	IC Document
Att F_Workplan Program Questions Screenshots_final.docx Workplan Program Quesions (screenshot)	IC Document

IC Title:

Agency IC Tracking Number:

0920-0106

IC Status: Unchanged

Obligation to Respond: Mandatory

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 and Instruction	0920-0106			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 61

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
	Requested	Previously Approved
Annual Number of Responses for this IC	61	61
Annual IC Time Burden (Hours)	610	610
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Workplan Program Quesions (screenshot)		01/29/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].