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CDC Model Performance Evaluation Program (MPEP) Enrollment Form
CDC Model Performance Evaluation Program (MPEP) for Retroviral and AIDS-Related Testing
OMB: 0920-0274
IC ID: 37750
OMB.report
HHS/CDC
OMB 0920-0274
ICR 200710-0920-010
IC 37750
( )
Documents and Forms
Document Name
Document Type
Attachment 3 Enrollment Form.doc
Other-Enrollment Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CDC Model Performance Evaluation Program (MPEP) Enrollment Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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-Enrollment Form
Attachment 3 Enrollment Form.doc
Yes
Yes
Printable 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:
100
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
100
0
-4,145
0
0
4,245
Annual IC Time Burden (Hours)
5
0
-1,052
0
0
1,057
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.