Information Collection Request

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

ICR 201007-0920-008 · OMB 0920-0555 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Local Public Health System Performance Assessment Instrument Form and Instruction Modified Available
SS_Part_B_5-28-2010.docx Supporting Statement B Uploaded 2010-07-15 Available
Att D_PossibleResp for use of NPHPSP Instr.xls Supplementary Document Uploaded 2010-07-15 Available
Att C_Work Group Members.doc Supplementary Document Uploaded 2010-07-15 Available
Att B 60 dy FRN-Local.pdf Supplementary Document Uploaded 2010-07-15 Available
Att A.pdf Supplementary Document Uploaded 2010-07-15 Available
Att H_Screen Shots_Web Based System.docx Supplementary Document Uploaded 2010-07-15 Available
Att G_ Data Entry Instructions_1007.docx Supplementary Document Uploaded 2010-07-15 Available
Att F_Mtg Guide.doc Supplementary Document Uploaded 2010-07-15 Available
Att E.4_Local Agency Contribution.pdf Supplementary Document Uploaded 2010-07-15 Available
Att E.3_Local Priority.pdf Supplementary Document Uploaded 2010-07-15 Available
Att E.2_Local RIF.pdf Supplementary Document Uploaded 2010-07-15 Available
Supp Stmt Part_A (Revised-2).docx Supporting Statement A Uploaded 2010-07-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
7006 Local Public Health System Performance Assessment Instrument Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2013 36 Months From Approved 08/31/2010
350 0 350
5,600 0 5,600
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Local Public Health System Performance Assessment Instrument 1 Local Public Health System Performance Assessment Instrument

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 350 350 0 0 0 0
Annual Time Burden (Hours) 5,600 5,600 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No