Information Collection

Mai Ppr

IC 272605 under ICR 202509-0930-005 · OMB 0930-0399.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form MAI PPR MAI PPR	Form and Instruction
Form MAI PPR MAI PPR MAI PPR	Form and Instruction
MAI PPR MAI PPR Attachment 2 - MAI-PPR Template (2025.05.27).docx	Form and Instruction
MAI PPR MAI PPR Attachment 2 - MAI-PPR Template (2025.05.27).docx	Form and Instruction

IC Title:

MAI PPR

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	MAI PPR				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: MAI SORN

FR Citation: 75 FR 28264

Number of Respondents: 8

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
	Approved	Previously Approved
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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