Assessment of the Model Performance Evaluation Program (MPEP)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Att1 MPEP Customer Feedback Survey.docx Other-WORD
0920-1027 Assessment of the Model Performance Evaluation Program ( Att2 MPEP Webshots Customer Feedback .docx Form and Instruction
RFA-Customer Feedback_ MPEP_Online.docx Request for Approval IC Document
CDC_PRA_Determination_Form_MPEP.pdf CDC_PRA Determination Form IC Document
NCHHSTP_Project-Determination-and-Approval-Form- MPEP_12-18-15_CW (002).pdf NCHHSTP_Project Determination IC Document

Information Collection (IC) Details

IC Title:	Assessment of the Model Performance Evaluation Program (MPEP)	Agency IC Tracking Number:	0920-1027 (18SY)

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
Other-WORD			Att1 MPEP Customer Feedback Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1027	Assessment of the Model Performance Evaluation Program (MPEP)	Att2 MPEP Webshots Customer Feedback .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 84	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	84	84
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	RFA-Customer Feedback_ MPEP_Online.docx	03/08/2018
CDC_PRA Determination Form	CDC_PRA_Determination_Form_MPEP.pdf	03/08/2018
NCHHSTP_Project Determination	NCHHSTP_Project-Determination-and-Approval-Form- MPEP_12-18-15_CW (002).pdf	03/08/2018

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