Information Collection

National Public Health Performance Standards Program Local Public Health System Performance Assessment

IC 7006 under ICR 200706-0920-001 · OMB 0920-0555.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0555 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 National Public Health Performance Standards Program Local Public Health System Performance Assessment	Form and Instruction
1 LOCAL PUBLIC HEALTH SYSTEM PERFORMANCE ASSESSMENT SYSTEM Attachment E Instruments Local.pdf www.NPHPSP-results.org	Form and Instruction
Attachment F Facilitator Guide Local v2.doc Attachment F Facilitator Guide Local v2	IC Document
Attachment G How to Enter NPHPSP Responses.pdf Attachment G How to Enter NPHPSP Responses	IC Document
Attachment H screenshot examples.pdf Attachment H screenshot examples	IC Document

IC Title:

National Public Health Performance Standards Program Local Public Health System Performance Assessment

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	LOCAL PUBLIC HEALTH SYSTEM PERFORMANCE ASSESSMENT SYSTEM VERSION 2.0	Attachment E Instruments Local.pdf	www.NPHPSP-results.org	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	350	175	175
Annual IC Time Burden (Hours)	5,600	1,400	4,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F Facilitator Guide Local v2	Attachment F Facilitator Guide Local v2.doc	05/07/2007
Attachment G How to Enter NPHPSP Responses	Attachment G How to Enter NPHPSP Responses.pdf	05/07/2007
Attachment H screenshot examples	Attachment H screenshot examples.pdf	05/07/2007

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