Information Collection

National Public Health Performance Standards Program Local Public Health Governance Performance Assessment Tool

IC 7041 under ICR 201008-0920-006 · OMB 0920-0580.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment E Govt booklet C.pdf	Instruction
Attachment E Govt booklet A.pdf	Instruction
Attachment E Govt booklet B.pdf	Instruction
Attachment F Meeting Guide.doc Attachment F Meeting Guide	IC Document
Attachment G NPHPSP Data Entry Instructions.doc Attachment G Data Enty Instructions	IC Document
Attachment H NPHPSP Reporting System Website Screen Shots.doc Attachment H Web Screen Shots	IC Document
NPHPSP Denominator .xls Attachment D Possible Respondents	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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment E Govt booklet C.pdf	Yes	Yes	Fillable Printable
Instruction	Attachment E Govt booklet A.pdf	Yes	Yes	Fillable Printable
Instruction	Attachment E Govt booklet B.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175

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	175	175
Annual IC Time Burden (Hours)	875	875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F Meeting Guide	Attachment F Meeting Guide.doc	07/27/2010
Attachment G Data Enty Instructions	Attachment G NPHPSP Data Entry Instructions.doc	07/27/2010
Attachment H Web Screen Shots	Attachment H NPHPSP Reporting System Website Screen Shots.doc	07/27/2010
Attachment D Possible Respondents	NPHPSP Denominator .xls	07/27/2010

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