PAsS Enrollment Form

NCEH DLS Laboratory Quality Assurance Programs

Documents and Forms

Document Name Document Type
PAsS Enrollment Form Form
PAsS Enrollment Form Att 3j. PAsS Enrollment Form.pdf Form
PAsS Enrollment Form Att 3j. PAsS Enrollment Form.pdf Form

Information Collection (IC) Details

IC Title:	PAsS Enrollment Form	Agency IC Tracking Number:	0920-22AW

Is this a Common Form? No		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	n/a	PAsS Enrollment Form	Att 3j. PAsS Enrollment Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	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 Agency Discretion
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	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.