Information Collection

Natinal Public Health Improvement Initiative: Program Assessment

IC 212458 under ICR 201402-0920-018 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.