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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.