BHPr Performance Measures Forms

BHPr Performance Report for Grants and Cooperative Agreements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0061 can be found here:

Documents and Forms

Document Name Document Type
Form B BHPr Performance Measures Forms Form and Instruction
CaPrimary Care Offices Measures.docx Other-Ca Doc Support
CbPerformance Measures.pdf Other-Cb Supporting Docs
CcDNPH Mapping 2015.pdf Other-Cc Supporting Doc
CdDMD Mapping 2015.pdf Other-Cd supporting Doc
CeDHCFS Mapping 2015.pdf Other-Ce Supporting Doc
Performance Measures.pdf Other-Cf Supporting Doc
B Progress Report AttachBProgressReport.docx Form and Instruction
C PRGCA AttachCPRGCA.docx Form and Instruction

Information Collection (IC) Details

IC Title:	BHPr Performance Measures Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B	Progress Report	AttachBProgressReport.docx	Yes	Yes	Fillable Fileable
Form and Instruction	C	PRGCA	AttachCPRGCA.docx	Yes	Yes	Fillable Fileable
Other-Ca Doc Support			CaPrimary Care Offices Measures.docx	Yes	No	Printable Only
Other-Cb Supporting Docs			CbPerformance Measures.pdf	Yes	No	Printable Only
Other-Cc Supporting Doc			CcDNPH Mapping 2015.pdf	Yes	No	Printable Only
Other-Cd supporting Doc			CdDMD Mapping 2015.pdf	Yes	No	Printable Only
Other-Ce Supporting Doc			CeDHCFS Mapping 2015.pdf	Yes	No	Printable Only
Other-Cf Supporting Doc			Performance Measures.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,557	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,557	-1,969	3,526
Annual IC Time Burden (Hours)	5,992	-1,745	7,737
Annual IC Cost Burden (Dollars)	0	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.