Information Collection

Data Use Agreement Conditions of Access to Confidential Data

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Use Agreement Conditions of Access to Confidential Data	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Data Use Agreement Conditions of Access to Confidential Data	OMB0920-1393_RDC Data Security Forms_Attachment C_06092026.pdf		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 %

	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

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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