Information Collection

Progress Monitoring Report for Evaluation of State Nutrition and Physical Activity Programs

IC 7137 under ICR 200805-0920-001 · OMB 0920-0669.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0669 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Progress Monitoring Report for Evaluation of State Nutrition and Physical Activity Programs	Form
No number Progress Monitoring Report Attachment C1 PMR.rev3.pdf	Form
Attachment D Evaluation Plan.doc Evaluation Plan	IC Document
Attachment C2 Table of PMR Revisions.r3.doc Table of Revisions	IC Document

IC Title:

Progress Monitoring Report for Evaluation of State Nutrition and Physical Activity Programs

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	No number	Progress Monitoring Report	Attachment C1 PMR.rev3.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

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
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	672	672
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Evaluation Plan	Attachment D Evaluation Plan.doc	03/20/2008
Table of Revisions	Attachment C2 Table of PMR Revisions.r3.doc	03/20/2008

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