Information Collection

Annual Reporting Tool

IC 241787 under ICR 202602-0930-002 · OMB 0930-0377.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Annual Reporting T Annual Reporting Tool Annual Reporting Tool	Form and Instruction
Annual Reporting T Annual Reporting Tool Attachment 1_SPF-Rx Annual Reporting Tool 05.31.2022CLEAN - 13July 22.docx	Form and Instruction

IC Title:

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	Annual Reporting Tool				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 135

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	135	4	131
Annual IC Time Burden (Hours)	203	-300	503
Annual IC Cost Burden (Dollars)	0	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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