Psr

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⚠️ Notice: This information collection may be referencing outdated material.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
F_Online Instrument - Web Version.docx Other-Web
E_Online Instrument - Word version.docx Other-WORD
G_Interview Guide.docx Other-WORD
GEL2-PSR-SSA.docx Supporting Statement A IC Document
GEL2-PSR-SSB.docx Supporting Statement B IC Document
A_Georgia PSR.pdf Att A_Georgia PSR IC Document
B_PSR Quick Start Guide.docx Att B_PSR Quick Start Guide IC Document
C_PSR National Summary.pdf Att C_ PSR National Summary IC Document
D_PSR 2011 Assessment Results.docx Att D_ PSR 2011 Assessment Results IC Document
H_Web Assessment Notification Email.docx Att H_Assessment Notification E-mail IC Document
I_Web Assessment Reminder Email.docx Att I_Assessment Reminder Email IC Document
J_Interview Notification Email.docx Att J_Interview Notification Email IC Document
K_Interview Follow-Up Email.docx Att K_Interview F/U Email IC Document

Information Collection (IC) Details

IC Title:	PSR	Agency IC Tracking Number:	15HA

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-Web	F_Online Instrument - Web Version.docx	Yes	Yes	Fillable Printable
Other-WORD	E_Online Instrument - Word version.docx	Yes	Yes	Fillable Printable
Other-WORD	G_Interview Guide.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 632	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	632	632
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	GEL2-PSR-SSA.docx	12/11/2014
Supporting Statement B	GEL2-PSR-SSB.docx	12/11/2014
Att A_Georgia PSR	A_Georgia PSR.pdf	12/11/2014
Att B_PSR Quick Start Guide	B_PSR Quick Start Guide.docx	12/11/2014
Att C_ PSR National Summary	C_PSR National Summary.pdf	12/11/2014
Att D_ PSR 2011 Assessment Results	D_PSR 2011 Assessment Results.docx	12/11/2014
Att H_Assessment Notification E-mail	H_Web Assessment Notification Email.docx	12/11/2014
Att I_Assessment Reminder Email	I_Web Assessment Reminder Email.docx	12/11/2014
Att J_Interview Notification Email	J_Interview Notification Email.docx	12/11/2014
Att K_Interview F/U Email	K_Interview Follow-Up Email.docx	12/11/2014

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