Information Collection

Project Evaluators

IC 220563 under ICR 201603-0930-004 · OMB 0930-0363.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BPI BHTCC Version Project Evaluators	Form and Instruction
BPI BHTCC Version BPI BHTCC Version Attachment A_BPI BHTCC Version.docx	Form and Instruction
18-Month Client-Le 18-Month Client-Level Abstraction Tool Attachment G_18-Month Client-Level Abstraction Tool.docx	Form and Instruction

IC Title:

Project Evaluators

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	BPI BHTCC Version	BPI BHTCC Version	Attachment A_BPI BHTCC Version.docx		Yes	Yes	Fillable Fileable
Form and Instruction	18-Month Client-Level Abstraction Tool	18-Month Client-Level Abstraction Tool	Attachment G_18-Month Client-Level Abstraction Tool.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17

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	51	51
Annual IC Time Burden (Hours)	118	118
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.