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Health Center Organizational Assessment
Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
OMB: 0920-1156
IC ID: 222374
OMB.report
HHS/CDC
OMB 0920-1156
ICR 201703-0920-010
IC 222374
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1156 can be found here:
2020-01-27 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Health Center Organizational Assessment
Form and Instruction
Health Center Organizational Assessment
Att 4 Health Center Org Assessment_6 22 2016.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Center Organizational Assessment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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 and Instruction
NA
Health Center Organizational Assessment
Att 4 Health Center Org Assessment_6 22 2016.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
4
0
0
0
0
4
Annual IC Time Burden (Hours)
8
0
0
0
0
8
Annual IC Cost Burden (Dollars)
0
0
0
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.