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Att D_ Law Enforcement Officials (Interview)
School Associated Violent Deaths Surveillance System
OMB: 0920-0604
IC ID: 191865
OMB.report
HHS/CDC
OMB 0920-0604
ICR 201601-0920-004
IC 191865
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:
2019-05-02 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Att D_Law Enforcement Interview Instrument.docx
Other-CATI
Att F_Law Enforcement Participation Letter.docx
Att F_Law Enforcement Paricipation Request Letter
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att D_ Law Enforcement Officials (Interview)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 242
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-CATI
Att D_Law Enforcement Interview Instrument.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
35
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
35
0
0
0
0
35
Annual IC Time Burden (Hours)
38
0
3
0
0
35
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att F_Law Enforcement Paricipation Request Letter
Att F_Law Enforcement Participation Letter.docx
01/12/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.