Information Collection

National Public Health Performance Standards Program State Public Health Performance Assessment

IC 7010 under ICR 200706-0920-002 · OMB 0920-0557.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0557 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 State Public Health Performance Assessment	Form and Instruction
1 Attachment E Instruments State Attachment E Instruments State.pdf www.NPHPSP-results.org	Form and Instruction
Attachment F FacilitatorGuide State v.2.doc Attachment F FacilitatorGuide State v	IC Document
Attachment G How to Enter NPHPSP Responses.pdf Attachment G How to Enter NPHPSP Responses	IC Document
Attachment H screenshot example State revised.pdf Attachment H screenshot example State revised	IC Document

IC Title:

National Public Health Performance Standards Program State Public Health 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	Attachment E Instruments State	Attachment E Instruments State.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: 8

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	8	1	7
Annual IC Time Burden (Hours)	96	-9	105
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F FacilitatorGuide State v	Attachment F FacilitatorGuide State v.2.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 example State revised	Attachment H screenshot example State revised.pdf	05/07/2007

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