Natinal Public Health Improvement Initiative: Program Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Att D_Interviewee Request Form.docx Other-WORD
Att F_Interview Guide.docx Other-WORD
Att E_Screenshots of Interviewee Request Form.docx Other-PDF
NPHII-QUAL-SSA.DOCX SupSta A IC Document
NPHII-QUAL-SSB.DOCX Sup Sta B IC Document
Att A_NPHII Awardees.docx Att A - Listring of NPHII Awardees IC Document
Att B_Mid-Program Report Executive Summary.pdf Att B_NPHII: Mid-Program Evaluation Report IC Document
Att C_NPHII Summative Assessment Questions and Data Sources.docx Att C - NPHII: Summative Assessment Qs & D Sources IC Document
Att G_Advance Notification Email.docx Att G_Adv Notification Email IC Document
Att H_Interview Invitation Email.docx Att H_ Interview Inv Email IC Document
Att I_Interview Confirmation Email.docx Att I_Interview Conf Email IC Document
Att J_Participant Reminder Email.docx Att J_Participant Reminder Email IC Document
Att K_Follow-up Invitation Email.docx Att K_F/U Inv Email IC Document

Information Collection (IC) Details

IC Title:	Natinal Public Health Improvement Initiative: Program Assessment	Agency IC Tracking Number:	14ARI

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Att D_Interviewee Request Form.docx	Yes	Yes	Fillable Printable
Other-WORD	Att F_Interview Guide.docx	No		Fillable Printable
Other-PDF	Att E_Screenshots of Interviewee Request Form.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 63	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 33 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	63	63
Annual IC Time Burden (Hours)	46	46
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SupSta A	NPHII-QUAL-SSA.DOCX	07/24/2014
Sup Sta B	NPHII-QUAL-SSB.DOCX	07/24/2014
Att A - Listring of NPHII Awardees	Att A_NPHII Awardees.docx	07/24/2014
Att B_NPHII: Mid-Program Evaluation Report	Att B_Mid-Program Report Executive Summary.pdf	07/24/2014
Att C - NPHII: Summative Assessment Qs & D Sources	Att C_NPHII Summative Assessment Questions and Data Sources.docx	07/24/2014
Att G_Adv Notification Email	Att G_Advance Notification Email.docx	07/24/2014
Att H_ Interview Inv Email	Att H_Interview Invitation Email.docx	07/24/2014
Att I_Interview Conf Email	Att I_Interview Confirmation Email.docx	07/24/2014
Att J_Participant Reminder Email	Att J_Participant Reminder Email.docx	07/24/2014
Att K_F/U Inv Email	Att K_Follow-up Invitation Email.docx	07/24/2014

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