Information Collection

Daily Reports of AGE Logs

IC 252598 under ICR 202603-0920-012 · OMB 0920-1260.

Documents and Forms

Document Name Document Type
Form 0920-1260 Daily Reports of AGE Logs Daily Reports of AGE Logs Form and Instruction
Form 0920-26-0121 VSP AGE Log Daily Reports of AGE Logs Form
0920-1260 Daily Reports of AGE Logs Att5b DailyReprtsAGELogTemplate 2018 20220125.xlsx Form and Instruction
0920-26-0121 VSP AGE Log Attachment 5b_VSP_AGE_Log_for ICR.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Daily Reports of AGE Logs	Agency IC Tracking Number:	0920-26-0121

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1260	Daily Reports of AGE Logs	Att5b DailyReprtsAGELogTemplate 2018 20220125.xlsx		Yes	Yes	Fillable Fileable
Form	0920-26-0121	VSP AGE Log	Attachment 5b_VSP_AGE_Log_for ICR.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,160	2,160
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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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