View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[CSTLTS] ATSDR Public Health Surveillance Stakeholder Input and Priorities	Agency IC Tracking Number:	0920-0879-23BB

IC Status: New

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/a	ATSDR Stakeholder Survey to Determine Surveillance Needs	Attachment A - Stakeholder Survey (Word).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: 90	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	90	0	90	0	0	0
Annual IC Time Burden (Hours)	32	0	32	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA	CSTLTS_Generic_Supporting_Statement_A_final.docx	11/16/2022
SSB	CSTLTS Generic Supporting_Statement_B.docx	11/16/2022
ATSDR Stakeholder Survey to Determine Surveillance Needs (web version)	Attachment B - Stakeholder Survey (Web).docx	11/16/2022
Survey Invitation	Attachment C - Survey Invitation.docx	11/16/2022
Survey Invitation Reminder	Attachment D - Survey Invitation Reminder.docx	11/16/2022

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