Information Collection

Assessing Effectiveness Brochure: LHD/NHHE Progam Working Together AND STD Prevention Services

IC 208743 under ICR 201110-0920-004 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att A - MS Word Instrument.docx	Other-WORD
Att H - HHE_Data collection instrument (web version) (2).docx	Other-WORD
Att G - HHE_Data collection instrument (Word).docx	Other-WORD
Att B - Web version Instrument.docx	Other-WORD
Att A1 - Data Collection Definitions.docx	Other-WORD
Att D - First Reminder E-Mail.docx Att D - First Reminder E-Mail	IC Document
Att A - NOA_0920-0260 11-2011.pdf Att A - NOA_0920-0260 11-2011	IC Document
Att B - Example HHE report.pdf Att B - Example HHE report	IC Document
Att C - National Academies brief report.pdf Att C - National Academies brief report	IC Document
Att D - Implementation Plan.pdf Att D - Implementation Plan	IC Document
Att E - HHE Strategic Plan FY2012 (2) (3).pdf Att E - HHE Strategic Plan FY2012 (2) (3)	IC Document
Att F - Brochure.pdf Att F - Brochure	IC Document
Att I - Invitation email.docx Att I - Invitation email	IC Document
Att J - Email reminder - day 7.docx Att J - Email reminder - day 7	IC Document
Att K - Email reminder- day 12.docx Att K - Email reminder- day 12	IC Document
HHE SupSta-A.docx HHE SupSta-A	IC Document
HHE SupSta-B.docx HHE SupSta-B	IC Document
Att C - Invitation E-Mail.docx Att C - Invitation E-Mail	IC Document
Att E - Second-Final Reminder E-Mail.docx Att E - Second-Final Reminder E-Mail	IC Document
SupSta A - STD Prev Serv.docx SupSta A - STD Prev Serv	IC Document
SupSta B - STD Prev Serv.docx SupSta B - STD Prev Serv	IC Document

IC Title:

Assessing Effectiveness Brochure: LHD/NHHE Progam Working Together AND STD Prevention Services

Agency IC Tracking Number:

IC Status: New

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
Other-WORD	Att A - MS Word Instrument.docx	Yes	Yes	Fillable Printable
Other-WORD	Att H - HHE_Data collection instrument (web version) (2).docx	Yes	Yes	Fillable Printable
Other-WORD	Att G - HHE_Data collection instrument (Word).docx	Yes	Yes	Fillable Printable
Other-WORD	Att B - Web version Instrument.docx	Yes	Yes	Fillable Printable
Other-WORD	Att A1 - Data Collection Definitions.docx	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 877

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	877	0	0	0	0	0
Annual IC Time Burden (Hours)	209	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D - First Reminder E-Mail	Att D - First Reminder E-Mail.docx	08/27/2013
Att A - NOA_0920-0260 11-2011	Att A - NOA_0920-0260 11-2011.pdf	08/27/2013
Att B - Example HHE report	Att B - Example HHE report.pdf	08/27/2013
Att C - National Academies brief report	Att C - National Academies brief report.pdf	08/27/2013
Att D - Implementation Plan	Att D - Implementation Plan.pdf	08/27/2013
Att E - HHE Strategic Plan FY2012 (2) (3)	Att E - HHE Strategic Plan FY2012 (2) (3).pdf	08/27/2013
Att F - Brochure	Att F - Brochure.pdf	08/27/2013
Att I - Invitation email	Att I - Invitation email.docx	08/27/2013
Att J - Email reminder - day 7	Att J - Email reminder - day 7.docx	08/27/2013
Att K - Email reminder- day 12	Att K - Email reminder- day 12.docx	08/27/2013
HHE SupSta-A	HHE SupSta-A.docx	08/27/2013
HHE SupSta-B	HHE SupSta-B.docx	08/27/2013
Att C - Invitation E-Mail	Att C - Invitation E-Mail.docx	08/27/2013
Att E - Second-Final Reminder E-Mail	Att E - Second-Final Reminder E-Mail.docx	08/27/2013
SupSta A - STD Prev Serv	SupSta A - STD Prev Serv.docx	08/27/2013
SupSta B - STD Prev Serv	SupSta B - STD Prev Serv.docx	08/27/2013

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