Information Collection

Annual Progress Report (subset of Interim Progress questions)

IC 264760 under ICR 202506-0920-003 · OMB 0920-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Annual Progress Report (subset of Interim Progress questions)	Form and Instruction
Annual Progress Report Worksheet Annual Progress Report (subset of Interim Progress questions)	Form and Instruction
Annual Progress Report Worksheet Att G_Annual Progress Report Worksheet (Word Version).docx	Form and Instruction
Annual Progress Report Worksheet Att G_Annual Progress Report Worksheet (Word Version).docx	Form and Instruction
Att H_Annual Progress Report Screenshots.docx Annual Progress Report (screenshot)	IC Document
Att H_Annual Progress Report Screenshots.docx Annual Progress Report (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

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)	427	427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annual Progress Report (screenshot)		01/29/2024

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

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