Att 5A_Annual Report Instrument

Preventive Health and Health Services Block Grant

OMB: 0920-0106

IC ID: 184866

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Att 5A_Annual Report Instrument
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att 5A_Annual Report Instrument.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

61 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 61 0 0 0 0 61
Annual IC Time Burden (Hours) 915 0 0 0 0 915
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 5B_AnnualReportGuidance Att 5B_AnnualReportGuidance.doc 05/23/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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