Information Collection

Grantee program staff

IC 199776 under ICR 201502-0990-004 · OMB 0990-0392.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-ACYF_PM_Instrument 1 Perceived Impact 8-9.docx	Other-survey
099-ACYF_PM Instrument 2 Reporting Form Reach 8-4.docx	Other-survey
0990-PPA_PM OMB ICR Instrument 2 Reporting Form Reach revised 2 2012.docx	Other-Instrument 2 Reporting Form Re
0990-PPA_PM OMB ICR Instrument 1 Perceived Impact revised 2 2012.docx	Other-Instrument 1 Perceived Impact

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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-survey	0990-ACYF_PM_Instrument 1 Perceived Impact 8-9.docx	Yes	Yes	Fillable Printable
Other-survey	099-ACYF_PM Instrument 2 Reporting Form Reach 8-4.docx	Yes	Yes	Fillable Printable
Other-Instrument 2 Reporting Form Reach revised 2 2012	0990-PPA_PM OMB ICR Instrument 2 Reporting Form Reach revised 2 2012.docx	Yes	Yes	Fillable Printable
Other-Instrument 1 Perceived Impact revised 2 2012	0990-PPA_PM OMB ICR Instrument 1 Perceived Impact revised 2 2012.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 107

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-214	214
Annual IC Time Burden (Hours)	-856	856
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.