Information Collection

New MIS Modules: Success Stories & Environmental Assessment

IC 184680 under ICR 201004-0920-005 · OMB 0920-0739.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0739 can be found here:

Documents and Forms

Document Name Document Type
Form No number New MIS Modules: Success Stories & Environmental Assessment Form
No number Attachment A - New MIS Modules Attachment A. New MIS Modules.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New MIS Modules: Success Stories & Environmental Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	No number	Attachment A - New MIS Modules	Attachment A. New MIS Modules.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4	4
Annual IC Time Burden (Hours)	-44	44
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.