Information Collection

Program-Level Instrument

IC 234465 under ICR 202110-0930-002 · OMB 0930-0384.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0384 can be found here:

Documents and Forms

Document Name Document Type
Form SOR_TOR Program Le Program-Level Instrument Form and Instruction
SOR_TOR Program Le SOR_TOR Program Level Tool SOR_TOR Program Level Tool Revisions 5-13-21 clean.docx Form and Instruction
SOR_TOR Program Le SOR_TOR Program Level Tool SOR_TOR Program Level Tool Revisions 5-13-21 clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Program-Level Instrument	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 and Instruction	SOR_TOR Program Level Tool	SOR_TOR Program Level Tool	SOR_TOR Program Level Tool Revisions 5-13-21 clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Program-Level Instrument	FR Citation: 75 FR 28264

Number of Respondents: 159	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	636	-800	1,436
Annual IC Time Burden (Hours)	191	-53	244
Annual IC Cost Burden (Dollars)	0	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.