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Federal forms, ICRs, and supporting documents

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Cluster Close-out Report

IC 236512 under ICR 202602-0920-009 · OMB 0920-0573.

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Form
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Cluster Close-out Report 0920-0573
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-0573 Annual-Closeout Cluster Report Form Att_3g Annual-Closeout Cluster Report Form.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

SORN 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC  57 FR 62812

59 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 148 0 0 0 0 148
Annual IC Time Burden (Hours) 148 0 0 0 0 148
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cluster Report Form Instructions Att_4f Cluster Report Form Instructions Nov 2025.pdf 02/23/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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