Information Collection

AIRS Interim and End of Year Report

IC 192746 under ICR 201304-0920-019 · OMB 0920-0853.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0853 can be found here:

Documents and Forms

Document Name Document Type
AIRS Interim and End of Year Report Form
AIRS Data Collection Instrument 10 Attachment 4 AIRS Data Collection Instrument (web) 20130423.pdf Form
11 Attachment 4 AIRS Data Collection Instrument (Word) 20130423.doc AIRS Data Collection Instrument (Word) 20130423 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AIRS Interim and End of Year Report	Agency IC Tracking Number:

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	none	AIRS Data Collection Instrument	10 Attachment 4 AIRS Data Collection Instrument (web) 20130423.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
AIRS Data Collection Instrument (Word) 20130423	11 Attachment 4 AIRS Data Collection Instrument (Word) 20130423.doc	04/30/2013

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