Special Emphasis Reports

Program Evaluation of CDC’s Core State Injury Prevention Program

Documents and Forms

Document Name Document Type
Form 0920-21GB Special Emphasis Reports Form and Instruction
0920-21GB Special Emphasis Report Examples Attachment K_Special Emphasis Report Example.xlsx Form and Instruction
0920-1365 SpecialEmphasisRpt_CoreSIPP Att K_SpecialEmphasisRpt.xlsx Form

Information Collection (IC) Details

IC Title:	Special Emphasis Reports	Agency IC Tracking Number:	0920-1365

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	0920-21GB	Special Emphasis Report Examples	Attachment K_Special Emphasis Report Example.xlsx		Yes	Yes	Fillable Fileable
Form	0920-1365	SpecialEmphasisRpt_CoreSIPP	Att K_SpecialEmphasisRpt.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	3	23
Annual IC Time Burden (Hours)	260	30	230
Annual IC Cost Burden (Dollars)	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.