Nomination

Pre-Evaluation Assessments of Nutrition, Physical Activity and Obesity Programs and Policies

Documents and Forms

Document Name Document Type
Form 1 Nomination Form and Instruction
1 Nutrition and Physical Activity Initiatives to Prevent O Att 4A_PROGRAM NOMINATION FORM - hardcopy.doc Form and Instruction
2 Nutrition and Physical Activity Initiatives to Prevent O Att 4B_Program Nomination form web-based screenshots.pdf Form and Instruction
Att 4C_Nomination Solicitation Email.doc Att 4C_Nomination Solicitation Email IC Document

Information Collection (IC) Details

IC Title:	Nomination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Nutrition and Physical Activity Initiatives to Prevent Obesity	Att 4A_PROGRAM NOMINATION FORM - hardcopy.doc		Yes	Yes	Paper Only
Form and Instruction	2	Nutrition and Physical Activity Initiatives to Prevent Obesity	Att 4B_Program Nomination form web-based screenshots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4C_Nomination Solicitation Email	Att 4C_Nomination Solicitation Email.doc	01/19/2012

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