View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	20140006XXX Measles FSM	Agency IC Tracking Number:	14AGH

IC Status: Unchanged

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
Other-WORD					Yes	Yes	Paper Only
Other-WORD					Yes	Yes	Fillable Printable
Other-PDF					No		Paper Only

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: 450	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	450	0	0	0	0	450
Annual IC Time Burden (Hours)	150	0	0	0	0	150
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Email Request		06/02/2014

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

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