Data for Demonstration Projects

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Demonstrating Capacity to Implement Policy and Environmental Cancer Control Interventions Funding Opportunity Announcement OMB Information
Form Approved: OMB No. 0920-0841
Exp. Date xx/xx/xxxx
Public reporting burden of this collection of information varies from 3 to 6 hours with an estimated average of 3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance
Officer, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0841).

Program Information: Edit Contact Information

Program Information: Edit Program Summary

Resources: Add Personnel

Resources: Edit Policy Taskforce/Workgroup

Resources Policy Taskforce/Workgroup Attachments

Resources: Add Partners

Resources: Add Contracts/Consultants

o

Yes
□
□

o

(enable options below)
Fully funded Amount:
Partially Funded Amount:
 Describe other funding sources

No
Amount:
Describe other funding sources

Financial: Add Leveraged Funds

Financial: Add In-Kind Funds

Planning: Data Sources - Standard Data Sources

Planning: Data Sources - Other Data Sources

Planning: Evaluation

Planning: Plans & Logic Models

Action Plan: Add Project Period Objectives

Action Plan: Add Project Period Objective Progress

Action Plan: Add Annual Objective

Action Plan: Add Annual Objective Progress

Action Plan: Add Annual Activities

Action Plan: Add Annual Objective Products