Information Collection

CleverCap App Setup

IC 263490 under ICR 202510-0920-002 · OMB 0920-1428.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1428 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CleverCap App Setup	Form and Instruction
Att 4e_CleverCap App Setup English CleverCap App Setup	Form and Instruction
Att 4e_CleverCap App Setup Spanish CleverCap App Setup	Form and Instruction
Att 4e_CleverCap App Setup_CLEAN.pdf	Instruction
Att 4e_CleverCap App Setup_CLEAN.pdf	Instruction
Att 4e_CleverCap App Setup English Att 4e_CleverCap App Setup _CLEAN.docx	Form and Instruction
Att 4e_CleverCap App Setup English Att 4e_CleverCap App Setup _CLEAN.docx	Form and Instruction
Att 4e_CleverCap App Setup Spanish Att 4e_CleverCap App Setup Spanish_CLEAN.docx	Form and Instruction
Att 4e_CleverCap App Setup Spanish Att 4e_CleverCap App Setup Spanish_CLEAN.docx	Form and Instruction

IC Title:

CleverCap App Setup

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a		Yes	Yes	Fillable Fileable
Form and Instruction	n/a		Yes	Yes	Fillable Fileable
Instruction		NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 134

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	134	134
Annual IC Time Burden (Hours)	23	23
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.

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