View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[NCIPC] Core State Injury Prevention Program (Core SIPP)	Agency IC Tracking Number:	0920-1050-24GM

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	0920-1050	Group TA Feedback	GroupTAFeedback_CoreSIPP_Att 2.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Individual TA Feedback	IndividualTAFeedback_CoreSIPP_Att 1.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: 320	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	320	0	320	0	0	0
Annual IC Time Burden (Hours)	54	0	54	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”	0920-1050_GenIC_CoreSIPP_TA Feedback.docx	06/20/2024
Privacy Act Determination	CORE SIPP-PII-Privacy Act-Determination-SSPO.pdf	06/20/2024

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