View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Interview Questionnaire	Agency IC Tracking Number:	0920-0740-25-0058

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	none	2024 Programming Questionnaire - English	Att 5a MMP 2024-2026 Questionnaire English.pdf		Yes	Yes	Fillable Fileable
Form	0920-25-0058	MMP Questionnaire	Att 1b_2024 EN MMP Paper Questionnaire v24.2_Clean.pdf		Yes	Yes	Fillable Fileable
Form	0920-25-0058	MMP Questionnaire _SPANISH	Att 1d_2024 SP MMP Paper Questionnaire v24.2_Clean.pdf		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: 7,760	Number of Respondents for Small Entity: 7,520

Affected Public: Individuals or Households

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	7,760	0	0	0	0	7,760
Annual IC Time Burden (Hours)	5,173	0	0	0	0	5,173
Annual IC Cost Burden (Dollars)	134,015	0	0	0	0	134,015

Documents for IC

Title	Document	Date Uploaded
2024 Programming Questionnaire - Spanish	Att 5b MMP 2024-2026 Questionnaire Spanish.pdf	04/10/2024

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