Information Collection

Assessment of the Model Performance Evaluation Program (MPEP)

IC 230291 under ICR 201705-0920-017 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.