Information Collection

Using Evaluation Results to Drive Decision-Making

IC 231579 under ICR 201705-0990-002 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0421Attachment A_Using Evaluation Results_Phase 2_Interview Instrument.docx	Other-interview
0990-0421 SSA_Use of Eval Results_5.22.18.docx SS_A	IC Document
0990-0421Cover sheet_Use of Evaluation Results_5.22.18.docx Coversheet	IC Document
0990-0421SSB_Use of Eval Results_5.22.18.docx SS_B	IC Document

IC Title:

Using Evaluation Results to Drive Decision-Making

Agency IC Tracking Number:

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-interview			0990-0421Attachment A_Using Evaluation Results_Phase 2_Interview Instrument.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS_A	0990-0421 SSA_Use of Eval Results_5.22.18.docx	05/25/2018
Coversheet	0990-0421Cover sheet_Use of Evaluation Results_5.22.18.docx	05/25/2018
SS_B	0990-0421SSB_Use of Eval Results_5.22.18.docx	05/25/2018

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