Information Collection

CBO CBA Assessment Tool

IC 222639 under ICR 201607-0920-011 · OMB 0920-1153.

Documents and Forms

Document Name Document Type
CBO CBA Assessment Tool Form
CBO CBA Assessment Att 3 CBO CBA Assessment Tool.docx Form
CBO CBA Assessment - screenshots Att 4 CBO CBA Assessment Tool Screen Shots.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CBO CBA Assessment Tool	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	CBO CBA Assessment	Att 3 CBO CBA Assessment Tool.docx		Yes	Yes	Fillable Fileable
Form	none	CBO CBA Assessment - screenshots	Att 4 CBO CBA Assessment Tool Screen Shots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	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
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	240	240
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.