Information Collection

(OD2A-S) Annual Performance Report and Work Plan

IC 238173 under ICR 202604-0920-006 · OMB 0920-1283.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1283 OD2A-S Annual Performance Report and Work Plan (OD2A-S) Annual Performance Report and Work Plan	Form and Instruction
0920-1283 OD2A-S Annual Performance Report and Work Plan Attachment 3d_OD2A-S Annual Performance Report and Work Plan.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1283

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1283				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

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
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-51	51
Annual IC Time Burden (Hours)	-561	561
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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