View Information Collection (IC)

View Information Collection (IC)

IC Title:	Annual Report, 2020-2023	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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/A	Annual Report data elements and screens	0841 Att 4a Revised MIS Data Elements FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	(New) Leadership tab data elements and screen shots	0841 Att 4b Summary of Proposed MIS Changes FINAL.docx		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Action Plan data elements and screen shots	0841 Att 4h CDMIS Action Plan Tab User Guide FINAL.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: 66	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	0	0	-66	0	0	66
Annual IC Time Burden (Hours)	0	0	-66	0	0	66
Annual IC Cost Burden (Dollars)	0	0	-2,581	0	0	2,581

Documents for IC

Title	Document	Date Uploaded
Example data entry screenshot	0841 Att 4c CDMIS Data Entry Screenshot FINAL.JPG	04/16/2020
Secure log-in screen shot	0841 Att 4d CDMIS Login Page Screenshot FINAL.JPG	04/16/2020

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