Information Collection

Weekly Tally Sheet

IC 201609 under ICR 202601-0930-001 · OMB 0930-0270.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Weekly Tally Sheet Weekly Tally Sheet	Form and Instruction
Form Weekly Tally Sheet Weekly Tally Sheet Weekly Tally Sheet	Form and Instruction
Weekly Tally Sheet Weekly Tally Sheet Attach C dtac-ccp-toolkit-weekly-tally-sheet-20250228-omb-noedits.pdf	Form and Instruction
Weekly Tally Sheet Weekly Tally Sheet Attach C dtac-ccp-toolkit-weekly-tally-sheet-20250228-omb-noedits.pdf	Form and Instruction

IC Title:

Weekly Tally Sheet

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	Weekly Tally Sheet				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Weekly Tally Sheet

FR Citation: 75 FR 28264

Number of Respondents: 800

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	41,600	41,600
Annual IC Time Burden (Hours)	8,320	8,320
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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