Information Collection

GPRA/NOMs

IC 187484 under ICR 201109-0930-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 GPRA Client Outcom GPRA/NOMs	Form and Instruction
GPRA Client Outcom GPRA Client Outcome Instrument Attachment 1 CSAT GPRA Client Outcome Instrument new questions OMB 3-1-10_v 3.doc	Form and Instruction

IC Title:

GPRA/NOMs

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	GPRA Client Outcome Instrument	GPRA Client Outcome Instrument	Attachment 1 CSAT GPRA Client Outcome Instrument new questions OMB 3-1-10_v 3.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 326,693

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	Previously Approved
Annual Number of Responses for this IC	1,061,956	11,720	1,050,236
Annual IC Time Burden (Hours)	85,498	19,172	66,326
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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