Information Collection

OWHPA Grantee Cross-Site Evaluation

IC 238901 under ICR 201708-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A - Interview guide_Grantee_OWHPA Cross-Site_12.18.19.docx	Other-Survey Instrument- Grantee
Attachment B - Interview guide_Program Partner_OWHPA Cross-Site_12.18.19.docx	Other-Surey Instrument- Program Part
FastTrack Generic Clearance Submission- OWH Prevention Awards OWHPA Cross Site Evaluation 12-3-19.docx OWHPA Cross-Site Evaluation FastTrack Memo	IC Document

IC Title:

OWHPA Grantee Cross-Site Evaluation

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-Survey Instrument- Grantee			Attachment A - Interview guide_Grantee_OWHPA Cross-Site_12.18.19.docx		No		Paper Only
Other-Surey Instrument- Program Partner			Attachment B - Interview guide_Program Partner_OWHPA Cross-Site_12.18.19.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

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	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OWHPA Cross-Site Evaluation FastTrack Memo	FastTrack Generic Clearance Submission- OWH Prevention Awards OWHPA Cross Site Evaluation 12-3-19.docx	12/12/2019

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