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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
N-SSATS
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
Between Cycles N-SSATS - A
Between Cycles N-SSATS - A
Attachment B1- N-SSATS 2017 questionnaire (Version A).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2016 questionnaire - B
N-SSATS 2016 questionnaire - B
Attachment B2- N-SSATS 2016 questionnaire (Version B).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2016 CATI questionnaire
N-SSATS 2016 CATI questionnaire
Attachment B5- N-SSATS 2016 CATI questionnaire.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2017 Questionnaire (Version A)
N-SSATS 2017 Questionnaire (Version A)
Attachment B1 - N-SSATS 2017 Questionnaire (Version A).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2016 Questionnaire (Version B)
N-SSATS 2016 Questionnaire (Version B)
Attachment B2 - N-SSATS 2016 Questionnaire (Version B).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:
17,000
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
17,000
0
0
0
0
17,000
Annual IC Time Burden (Hours)
10,370
0
0
0
0
10,370
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
N-SSATS 2016 screens
Attachment B4- N-SSATS 2016 screens for online questionnaire.pdf
10/08/2015
N-SSATS 2016 Advance Letter
Attachment B6-N-SSATS 2016 Advance Letter.docx
10/08/2015
N-SSATS 2016 cover letter, online questionnaire access
Attachment B7- N-SSATS 2016 cover letter, online questionnaire access instructions, and frequently asked questions sheet.docx
10/08/2015
N-SSATS 2016 thank you
Attachment B8- N-SSATS 2016 thank you_reminder letter.docx
10/08/2015
N-SSATS 2016 second mailing
Attachment B9- N-SSATS 2016 second mailing cover letter .docx
10/08/2015
NSSATS Third Mailing
Attachment B10- NSSATS Third Mailing Cover Letter..docx
10/08/2015
N-SSATS 2016 completion thank you
Attachment B11- N-SSATS 2016 completion thank you letter.docx
10/08/2015
Web pages for the 2016 N-SSATS
Attachment B13- Web pages for the 2016 N-SSATS information website .pdf
10/08/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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