CSAT Client-Level Data

Common Data Platform

Documents and Forms

Document Name Document Type
Form CSAT Instrument CSAT Client-Level Data Form and Instruction
CSAT Instrument CSAT Instrument Attachment 6 Final CSAT Instrument 1.12.15.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CSAT Client-Level Data	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
Form and Instruction	CSAT Instrument	CSAT Instrument	Attachment 6 Final CSAT Instrument 1.12.15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 887,756	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,257,647	1,257,647
Annual IC Time Burden (Hours)	321,085	321,085
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.