Information Collection

Program-Level Instrument

IC 234465 under ICR 202410-0930-002 · OMB 0930-0384.

Documents and Forms

Document Name Document Type
Form SOR TOR Final Tool Program-Level Instrument Form and Instruction
SOR TOR Final Tool SOR TOR Final Tool SOR TOR Final Tool.docx Form and Instruction
SOR TOR FInal Tool SOR TOR Final Tool SOR TOR Final Tool CLEAN 12-2-24.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 FInal Tool	SOR TOR Final Tool	SOR TOR Final Tool CLEAN 12-2-24.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: 378	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	945	309	636
Annual IC Time Burden (Hours)	274	83	191
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.