Information Collection

GPRA/NOMs

IC 187484 under ICR 200812-0930-001 · OMB 0930-0208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0208 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CSAT GPRA Form and GPRA/NOMs	Form and Instruction
CSAT GPRA Form and CSAT GPRA Form and Instructions Attachment 1 CSAT GPRA Client Outcome Instrument new questions OMB 10-21-08.doc	Form and Instruction
Attachment 2 GPRA Matrix.doc Attachment 2 - Matrix	IC Document
Attachment 3 Data Entry Screens.doc Attachment 3 - Web Screens	IC Document
Attachment 4 Consent Form.doc Attachment 4 - Consent Form	IC Document
Attachment 5 Sample Reports.doc Attachment 5 - Reports	IC Document

IC Title:

GPRA/NOMs

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	CSAT GPRA Form and Instructions	CSAT GPRA Form and Instructions	Attachment 1 CSAT GPRA Client Outcome Instrument new questions OMB 10-21-08.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 326,586

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	1,050,236	1,050,236
Annual IC Time Burden (Hours)	66,326	66,326
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2 - Matrix	Attachment 2 GPRA Matrix.doc	12/01/2008
Attachment 3 - Web Screens	Attachment 3 Data Entry Screens.doc	12/01/2008
Attachment 4 - Consent Form	Attachment 4 Consent Form.doc	12/01/2008
Attachment 5 - Reports	Attachment 5 Sample Reports.doc	12/01/2008

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