Information Collection

Data Use Agreement Conditions of Access to Confidential Data

IC 258798 under ICR 202606-0920-007 · OMB 0920-1393.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Data Use Agreement Conditions of Access to Confidential Data Data Use Agreement Conditions of Access to Confidential Data	Form and Instruction
Data Use Agreement Conditions of Access to Confidential OMB0920-1393_RDC Data Security Forms_Attachment C_06092026.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0148

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	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Care Statistics

FR Citation: 49 FR 37697

Number of Respondents: 110

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	110	110
Annual IC Time Burden (Hours)	110	110
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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