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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.