Information Collection

Assessment of the STD AAPPS Funding Program

IC 225570 under ICR 201412-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Assessment of the STD AAPPS Funding Program	Form
Attachment D - Interview Guide.docx	Other-Interview Guide
STD AAPPS Assessment Tool Attachment C - Instrument - Electronic Version.pdf	Form
Attachment A - List of Awardee Respondents.docx List of Awardees	IC Document
Attachment E - Notification Email.docx Notification Email	IC Document
Attachment F - Reminder Email.docx Reminder Email	IC Document
Attachment G - Extension Email.docx Follow-up Email	IC Document
Attachment H Reminder Email Interview.docx Interview Reminder Email	IC Document
AAPPS-SSB.docx Supporting Statement B	IC Document
Attachment B - Instrument Word Version.docx Instrument - Word version	IC Document
AAPPS-SSA LATEST.docx Supporting Statement A	IC Document

IC Title:

Assessment of the STD AAPPS Funding Program

Agency IC Tracking Number:

17QU

IC Status: New

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	none	STD AAPPS Assessment Tool	Attachment C - Instrument - Electronic Version.pdf		Yes	Yes	Fillable Fileable
Other-Interview Guide			Attachment D - Interview Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 118

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
Annual Number of Responses for this IC	118	118
Annual IC Time Burden (Hours)	197	197
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
List of Awardees	Attachment A - List of Awardee Respondents.docx	02/06/2017
Notification Email	Attachment E - Notification Email.docx	02/06/2017
Reminder Email	Attachment F - Reminder Email.docx	02/06/2017
Follow-up Email	Attachment G - Extension Email.docx	02/06/2017
Interview Reminder Email	Attachment H Reminder Email Interview.docx	02/06/2017
Supporting Statement B	AAPPS-SSB.docx	02/06/2017
Instrument - Word version	Attachment B - Instrument Word Version.docx	02/06/2017
Supporting Statement A	AAPPS-SSA LATEST.docx	02/06/2017

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