View Information Collection (IC)

View Information Collection (IC)

IC Title:	Donor	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Federal CCF	Federal CCF	Att C Fed CCF.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	DOT Federal CCF	DOT Federal CCF	DOT 2013_Fed CCF.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: 5,400,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	5,400,000	0	0	-750,000	0	6,150,000
Annual IC Time Burden (Hours)	432,000	0	0	-80,500	0	512,500
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Leg and Exec Order 12564	Att A Executive Order 12564.pdf	04/27/2017
UrMG	Att B URMG revised 2017.pdf	04/27/2017

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