4--Grantee Annual Report on Coalition Functioning, Cost-Effectiveness, and Sustainability Planning

Evaluation of the Office on Women's Health (OWH) Coalition for a Healthier Community (CHC) Initiative

Documents and Forms

Document Name Document Type
0990-CHC_Grantee Annual Report on Coalition Functioning Cost-Effectiveness and Sustainability Planning.doc Other-report

Information Collection (IC) Details

IC Title:	4--Grantee Annual Report on Coalition Functioning, Cost-Effectiveness, and Sustainability Planning	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-report			0990-CHC_Grantee Annual Report on Coalition Functioning Cost-Effectiveness and Sustainability Planning.doc		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	40	40
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.