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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
N-SSATS 2019 Screens for Online Questionnaire
N-SSATS 2019 Screens for Online Questionnaire
Attachment B4 N-SSATS 2019 screens for online questionnaire.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
CATI Questionnaire
CATI Questionnaire
Attachment B5- N-SSATS 2019 CATI questionnaire.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2019 questionnaire (Version A)
N-SSATS 2019 questionnaire (Version A)
Attachment B1 N-SSATS 2019 questionnaire (Version A).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2020 questionnaire (Version B)
N-SSATS 2020 questionnaire (Version B)
Attachment B2 N-SSATS 2020 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)
11,333
0
963
0
0
10,370
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
N-SSATS 2019 Advance Letter
Attachment B6- N-SSATS 2019 Advance letter.pdf
10/12/2018
N-Cover Letter
Attachment B7- N-SSATS cover letter, online questionnaire access instructions, and frequently asked questions sheet.pdf
10/12/2018
N-SSATS 2019 Thank You_Reminder Letter
Attachment B8- N-SSATS 2019 thank you_reminder letter.pdf
10/12/2018
N-SSATS 2019 Second Mailing Cover Letter
Attachment B9- N-SSATS 2019 second mailing cover letter.pdf
10/12/2018
N-SSATS Third Mailing Cover Letter
Attachment B10- N-SSATS third mailing cover letter.pdf
10/12/2018
N-SSATS 2019 Completion ThankYou Letter
Attachment B11- N-SSATS 2019 completion thank you letter.pdf
10/12/2018
Web Pages 2019 N-SSATS Information Website
Attachment B13- Web pages for the 2019 N-SSATS information website.pdf
10/12/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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