Information Collection

Attachments 1 - 6

IC 275803 under ICR 202506-3041-003 · OMB unassigned.

Documents and Forms

Document Name Document Type
Form AttachmentForm_1_2-V1.2.pdf Other-Attachments Form
Form AttachmentForm_1_2-V1.2.pdf Other-Attachments Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachments 1 - 6	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-Attachments Form			Form AttachmentForm_1_2-V1.2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	880	880
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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