Information Collection

Project Evaluators - State/Tribal

IC 178432 under ICR 201308-0930-001 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form H1. EIRF Analysis Project Evaluators - State/Tribal	Form and Instruction
H1. EIRF Analysis H1. EIRF Analysis Form (EIRF) H1. EIRF Analysis Form (EIRF).docx	Form and Instruction
Project Evaluator--StateTribal & Campus Other Documents.pdf Project Evaluator--StateTribal & Campus Other Documents	IC Document

IC Title:

Project Evaluators - State/Tribal

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	H1. EIRF Analysis Form (EIRF)	H1. EIRF Analysis Form (EIRF)	H1. EIRF Analysis Form (EIRF).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 243

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	873	-2,199	3,072
Annual IC Time Burden (Hours)	1,603	1,139	464
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Project Evaluator--StateTribal & Campus Other Documents	Project Evaluator--StateTribal & Campus Other Documents.pdf	08/17/2013

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