Information Collection

Work Plan Tool - Annual Reporting

IC 221589 under ICR 201605-0920-009 · OMB 0920-1130.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1130 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Work Plan Tool - Annual Reporting	Form
Rape Prevention and Education Work PlanTool Att._3b_Work_Plan_Tool_Screenshots_041416.pdf	Form

IC Title:

Work Plan Tool - Annual Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	none	Rape Prevention and Education Work PlanTool	Att._3b_Work_Plan_Tool_Screenshots_041416.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

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	55	55
Annual IC Time Burden (Hours)	165	165
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.