OMB
.report
Search
Epidemiological Research Request -- State and Local Government
Epidemiological Research Request
OMB: 0960-0701
IC ID: 9755
OMB.report
SSA
OMB 0960-0701
ICR 201308-0960-013
IC 9755
( )
Documents and Forms
Document Name
Document Type
Current Epidemiological Research Review Information Application and Confidentiality Agreement.pdf
www.ssa.gov/policy/about/epidemiology.html
Other-Internet Screens
Previously Approved Epidemiological Research Review Information, Application and Confidentiality Agreement.pdf
Previously Approved Epidemiological Research Review Internet Screens
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Epidemiological Research Request -- State and Local Government
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
20 CFR 401.165
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Internet Screens
Current Epidemiological Research Review Information Application and Confidentiality Agreement.pdf
http://www.ssa.gov/policy/about/epidemiology.html
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Science and Innovation
Subfunction:
Scientific and Technological Research and Innovation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
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
15
0
0
0
0
15
Annual IC Time Burden (Hours)
30
0
0
0
0
30
Annual IC Cost Burden (Dollars)
52,500
0
0
-2,475
0
54,975
Documents for IC
Title
Document
Date Uploaded
Previously Approved Epidemiological Research Review Internet Screens
Previously Approved Epidemiological Research Review Information, Application and Confidentiality Agreement.pdf
10/23/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.