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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.