Information Collection

Annual Program Performance Report

IC 7549 under ICR 201105-0930-004 · OMB 0930-0169.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0169 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment B1 FY 2 Annual Program Performance Report	Form and Instruction
Attachment B1 FY 2 Attachment B1 FY 2011 Attachment B1 FY 2011 - 2014 8.12.11-FINAL.doc	Form and Instruction
Attachment A PAIMI PPR mailing letter 4.8.11.docx Attachment A PAIMI PPR mailing letter	IC Document
Attachment C Comment.pdf Attachment C Comment	IC Document

IC Title:

Annual Program Performance Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	Attachment B1 FY 2011	Attachment B1 FY 2011	Attachment B1 FY 2011 - 2014 8.12.11-FINAL.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	57	57
Annual IC Time Burden (Hours)	1,482	1,482
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A PAIMI PPR mailing letter	Attachment A PAIMI PPR mailing letter 4.8.11.docx	04/26/2011
Attachment C Comment	Attachment C Comment.pdf	04/15/2011

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