Information Collection

Work Plan Tool - Initial Population

IC 221587 under ICR 201703-0920-012 · OMB 0920-1130.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Work Plan Tool - Initial Population	Form
Rape Prevention and Education Work Plan Tool Att._3b_Work_Plan_Tool_Screenshots_041416.pdf	Form
WPT (Updated) Work Plan Tool Approved_Work_Plan_Tool_OMB 0920-1130.docx	Form
Att._3a_Work_Plan_Tool_041416.docx Rape Prevention and Education Work Plan Tool - Word	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 Plan Tool	Att._3b_Work_Plan_Tool_Screenshots_041416.pdf		Yes	Yes	Fillable Fileable
Form	WPT	(Updated) Work Plan Tool	Approved_Work_Plan_Tool_OMB 0920-1130.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

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	Previously Approved
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Rape Prevention and Education Work Plan Tool - Word	Att._3a_Work_Plan_Tool_041416.docx	05/19/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.