Information Collection

NPCR - Program Evaluation Instrument (NPCR-PEI)

IC 37809 under ICR 201304-0920-015 · OMB 0920-0706.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0706 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NPCR - Program Evaluation Instrument (NPCR-PEI)	Form
NPCR Program Evaluation Att 3A_0706_PEI Instrument Screenshots_2013.docx	Form
Att 3B_0706_Sample Letter w Inst_2012.docx Att 3b - Sample Letter	IC Document
Att 3C_Summary of Proposed Changes.docx Att 3c - Summary of Changes	IC Document

IC Title:

NPCR - Program Evaluation Instrument (NPCR-PEI)

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	none	NPCR Program Evaluation	Att 3A_0706_PEI Instrument Screenshots_2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3b - Sample Letter	Att 3B_0706_Sample Letter w Inst_2012.docx	04/18/2013
Att 3c - Summary of Changes	Att 3C_Summary of Proposed Changes.docx	04/18/2013

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