Information Collection

Survey Study -- Current State and Local Government Agencies

IC 202583 under ICR 201206-0910-001 · OMB 0910-0726.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0726 can be found here:

Documents and Forms

Document Name Document Type
Survey Cover Letter and Census Directions FINAL 8-31-12.doc Other-Cover Letter and Directions
SURVEY 205(c) FINAL 9-27-12.doc Other-Survey
FSMA 205c2 Draft Reminder FINA 8-31-12L.doc Other-Reminder

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey Study -- Current State and Local Government Agencies	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Cover Letter and Directions	Survey Cover Letter and Census Directions FINAL 8-31-12.doc	Yes	No	Printable Only
Other-Survey	SURVEY 205(c) FINAL 9-27-12.doc	Yes	Yes	Fillable Fileable
Other-Reminder	FSMA 205c2 Draft Reminder FINA 8-31-12L.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,391	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,391	1,391
Annual IC Time Burden (Hours)	1,391	1,391
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.