Awardee Lead Profile Assessment (ALPA) Questionnaire

Awardee Lead Profile Assessment (ALPA)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.