View Information Collection (IC)

View Information Collection (IC)

IC Title:	GDTA - TA	Agency IC Tracking Number:

IC Status: New

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	Survey	Survey	GDTA Satisfaction Attachment A 20151123.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	500	0	500	0	0	0
Annual IC Time Burden (Hours)	50	0	50	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Email Letters	GDTA Satsifaction Attachment B 20151123.docx	12/02/2015
Screen shots	GDTA Satisfaction Attachment C 20150911.docx	12/02/2015
Supporting Statement	GDTA Satisfaction Expedited Supporting Statement 20151130.docx	12/02/2015
Transmittal Letter	Trans.Let-7-2015.doc	12/02/2015

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