Information Collection

National Public Health Performance Standards Program State Public Health Performance Assessment

IC 7010 under ICR 201008-0920-005 · OMB 0920-0557.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0557 National Public Health Performance Standards Program State Public Health Performance Assessment	Form and Instruction
0920-0557 NPHPSP Reporting System NPHPSP Reporting System Version 2 - Website Screen Shots.docx	Form and Instruction
Meeting Guide - STATE 4-08.doc Meeting Guide State	IC Document
NPHPSP v2 Data Entry Instructions_1007.docx Data Entry Instructions	IC Document
NPHPSP Denominators.docx NPHPSP Denominators	IC Document
Meeting Guide - GOV 4-08.doc Meeting Guide Gov	IC Document

IC Title:

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	0920-0557	NPHPSP Reporting System	NPHPSP Reporting System Version 2 - Website Screen Shots.docx		Yes	Yes	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Meeting Guide State	Meeting Guide - STATE 4-08.doc	07/23/2010
Data Entry Instructions	NPHPSP v2 Data Entry Instructions_1007.docx	07/23/2010
NPHPSP Denominators	NPHPSP Denominators.docx	07/23/2010
Meeting Guide Gov	Meeting Guide - GOV 4-08.doc	07/23/2010

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