Enhanced Awardees Initial Evaluation

Monitoring and Reporting System for the State Public Health Actions Cooperative Agreements

Documents and Forms

Document Name Document Type
Enhanced Awardees Initial Evaluation Form
Enhanced Awardees Initial Evaluation Att 4d. Evaluation Work Plan (Enhanced).docm Form

Information Collection (IC) Details

IC Title:	Enhanced Awardees Initial Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Enhanced Awardees Initial Evaluation	Att 4d. Evaluation Work Plan (Enhanced).docm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	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	11	11
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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