Annual Performance Survey

National Resource Center for Mental Health Promotion and Youth Violence Prevention

Documents and Forms

Document Name Document Type
Form Annual Performance Annual Performance Survey Form and Instruction
Annual Performance Annual Performance Assessment NRC OMB Attachment 3 Annual Performance Assessment 11-2-16.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Performance Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	Annual Performance Assessment	Annual Performance Assessment	NRC OMB Attachment 3 Annual Performance Assessment 11-2-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 183	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	183	183
Annual IC Time Burden (Hours)	92	92
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.