Information Collection

Awardee Lead Profile Assessment (ALPA) Questionnaire

IC 228696 under ICR 201710-0920-009 · OMB 0920-1215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1215 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Awardee Lead Profile Assessment (ALPA) Questionnaire	Form and Instruction
ALPA Questionnaire - Web version Att 5 ALPA_EpiInfo web version_08-01-2017.PDF	Form and Instruction
ALPA Questionnaire - Word format Att 6 ALPA_word doc_email_07-25-2017.docx	Form and Instruction

IC Title:

Awardee Lead Profile Assessment (ALPA) Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	NA	ALPA Questionnaire - Web version	Att 5 ALPA_EpiInfo web version_08-01-2017.PDF	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	ALPA Questionnaire - Word format	Att 6 ALPA_word doc_email_07-25-2017.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

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	48	48
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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