Information Collection

Government Performance and Results Act Client/Participant Outcome Measures

IC 7607 under ICR 200701-0930-004 · OMB 0930-0208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0208 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1-1 CSA Government Performance and Results Act Client/Participant Outcome Measures	Form and Instruction
Attachment 1-1 CSA Attachment 1-1 CSAT Instructions 1 Attachment 1-1 GPRA CSAT instructions 2006.doc	Form and Instruction
Attachment 2-1 CSA Attachment 2-1 CSAP Instructions 2 Attachment 2-1 GPRA CSAP instructions 2006.doc	Form and Instruction
Attachment 1-2 CSA Attachment 1-2 CSAT Instruments 1 Attachment 1-2 CSAT GPRA Client Outcome instrument.doc	Form and Instruction
Attachment 2-2 CSA Attachment 2-2 CSAP Instruments 2 Attachment 2-2 GPRA CSAP instrument.doc	Form and Instruction
3 Attachment 3 GPRA Matrix.doc Attachment 3 - Matrix	IC Document
4 Attachment 4 Data Entry Screens.doc Attachment 4 - Screens	IC Document
5 Attachment 5 Consent Form.doc Attachment 5 - Consent Form	IC Document
6 Attachment 6 Reports.doc Attachment 6 - Reports	IC Document
1 0208Terms Memo 1-3-07.doc Terms of Clearance Memo	IC Document

IC Title:

Government Performance and Results Act Client/Participant Outcome Measures

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 1-1 CSAT Instructions	Attachment 1-1 CSAT Instructions	1 Attachment 1-1 GPRA CSAT instructions 2006.doc	No	No	Paper Only
Form and Instruction	Attachment 2-1 CSAP Instructions	Attachment 2-1 CSAP Instructions	2 Attachment 2-1 GPRA CSAP instructions 2006.doc	No	No	Paper Only
Form and Instruction	Attachment 1-2 CSAT Instruments	Attachment 1-2 CSAT Instruments	1 Attachment 1-2 CSAT GPRA Client Outcome instrument.doc	No	No	Paper Only
Form and Instruction	Attachment 2-2 CSAP Instruments	Attachment 2-2 CSAP Instruments	2 Attachment 2-2 GPRA CSAP instrument.doc	No	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,000	585,237	-918,047	337,810
Annual IC Time Burden (Hours)	3,564	0	-21,396	24,960
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3 - Matrix	3 Attachment 3 GPRA Matrix.doc	01/08/2007
Attachment 4 - Screens	4 Attachment 4 Data Entry Screens.doc	01/08/2007
Attachment 5 - Consent Form	5 Attachment 5 Consent Form.doc	01/08/2007
Attachment 6 - Reports	6 Attachment 6 Reports.doc	01/08/2007
Terms of Clearance Memo	1 0208Terms Memo 1-3-07.doc	01/08/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.