Information Collection

Att D-3_Reye Syndrome

IC 219460 under ICR 202601-0920-004 · OMB 0920-0009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0009 Att D-3_Reye Syndrome	Form and Instruction
Form 0920-0009 Reye Syndrome form Att D-3_Reye Syndrome	Form and Instruction
0920-0009 Reye Syndrome form D3. Reye Syndrome Form.pdf	Form and Instruction
0920-0009 Reye Syndrome form D3. Reye Syndrome Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-0009

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	0920-0009				No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	1	1
Annual IC Time Burden (Hours)	1	1
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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