Information Collection

Annual Comprehensive Self-Assessment

IC 227346 under ICR 201704-0583-003 · OMB 0583-0170.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0583-0170 can be found here:

Documents and Forms

Document Name Document Type
At_Least_Equal_to_Guidelines November 2016.pdf Other-guidance

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Comprehensive Self-Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-guidance			At_Least_Equal_to_Guidelines November 2016.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	27	27
Annual IC Time Burden (Hours)	5,049	5,049
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.