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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 2021 Questionnaire (Version A)
N-SSATS 2021 Questionnaire (Version A)
Attachment B1_as of 2020-02-26_N-SSATS 2021 Questionnaire (Version A).DOCX
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2022 Questionnaire (Version B)
N-SSATS 2022 Questionnaire (Version B)
Attachment B2_as of 2020-02-26_N-SSATS 2022 Questionnaire (Version B).DOCX
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2021 Screens for Online Questionnaire
N-SSATS 2021 Screens for Online Questionnaire
Attachment B4_as of 2020-02-26_N-SSATS 2021 screens for online questionnaire.docx
Yes
Yes
Fillable Fileable
Form and Instruction
N-SSATS 2021 CATI Questionnaire
N-SSATS 2021 CATI Questionnaire
Attachment B5_as of 2020-02-26_N-SSATS 2021 CATI Questionnaire.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:
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
0
0
0
11,333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
N-SSATS 2021 Advance Letter
Attachment B6_as of 2020-02-26_N-SSATS 2021 Advance Letter.docx
06/04/2020
N-SSATS 2021 Second Mailing Cover Letter
Attachment B11_as of 2020-02-26_N-SSATS 2021 Second Mailing Cover Letter.docx
06/04/2020
N-SSATS 2021 Third Mailing Cover Letter
Attachment B12_as of 2020-02-26_N-SSATS 2021 Third Mailing Cover Letter.DOCX
06/04/2020
N-SSATS 2021 Thank You Reminder Letter
Attachment B10_as of 2020-02-26_N-SSATS 2021 Thank You Reminder Letter.docx
06/04/2020
N-SSATS 2021 Completion Thank You Letter
Attachment B13_as of 2020-02-26_N-SSATS 2021 Completion Thank You Letter.DOCX
06/04/2020
Webpages for the N-SSATS 2021 Information website
Attachment B15_as of 2020-02-26_Web pages for the 2021 N-SSATS information website.pdf
06/04/2020
N-SSATS 2021 First Mailing Cover Letter
Attachment B7_as of 2020-02-26_N-SSATS 2021 First Mailing Cover Letter.docx
06/04/2020
N-SSATS 2021 Online Questionnaire Access Instructions
Attachment B8_as of 2020-02-26_N-SSATS 2021 Online Questionnaire Access Instructions.docx
06/04/2020
N-SSATS 2021 Frequently Asked Questions
Attachment B9_as of 2020-02-26_N-SSATS 2021 Frequently Asked Questions sheet.docx
06/04/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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