Information Collection

Grantee program staff-Tier 1 C/D, Tier 2, and PREIS grantees

IC 216296 under ICR 201502-0990-004 · OMB 0990-0392.

Documents and Forms

Document Name Document Type
0990-0392Appendix D TPP Performance Measures and questions participant level measures cd tier2 grantees only 9 2014 (3) (3).pdf Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Grantee program staff-Tier 1 C/D, Tier 2, and PREIS grantees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			0990-0392Appendix D TPP Performance Measures and questions participant level measures cd tier2 grantees only 9 2014 (3) (3).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	45	45
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.