Information Collection

Office of Population Affairs (OPA) Title X Grantee Needs Assessment Survey

IC 241507 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
1-Office of Population Affairs Title X Grantee Needs Assessment Surveys_PRA Form OMB Control No. 0990-0379_FINAL (002).docx Other-needs assessment survey with s
1-Office of Population Affairs Title X Grantee Needs Assessment Surveys_PRA Form OMB Control No. 0990-0379_FINAL (002).docx Office Population Affairs Title X Grantee Needs Assessment Fast track memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Office of Population Affairs (OPA) Title X Grantee Needs Assessment Survey	Agency IC Tracking Number:

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-needs assessment survey with scripts and instructions			1-Office of Population Affairs Title X Grantee Needs Assessment Surveys_PRA Form OMB Control No. 0990-0379_FINAL (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,680	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,680	1,680
Annual IC Time Burden (Hours)	420	420
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Office Population Affairs Title X Grantee Needs Assessment Fast track memo	1-Office of Population Affairs Title X Grantee Needs Assessment Surveys_PRA Form OMB Control No. 0990-0379_FINAL (002).docx	04/23/2020

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