Information Collection

NCCCP Program Improvement Assessment

IC 242393 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NCCCP Program Improvement Assessment	Form
NCCCP Assessment - word Attachment C_NCCCP Awardees Data Collection Instrument_Word Version.docx	Form
NCCCP Assessment Attachment D_NCCCP Awardees Data Collection Instrument_Web Version.docx	Form
Attachment A_Awarded Jurisdictions.docx Awarded jurisdictions	IC Document
Attachment B_Letters for Bona Fide Fiscal Agents.pdf Letters for fiscal agents	IC Document
Attachment E_Introductory Email.docx Introductory email	IC Document
Attachment F_Invitation Email.docx Invitation email	IC Document
Attachment G_Reminder Email.docx Reminder email	IC Document
Attachment H _Thank You Email.docx Thank you email	IC Document
NCCCP-EVAL-SSA.docx Supporting statement A	IC Document
NCCCP-EVAL-SSB.docx Supporting statement B	IC Document

IC Title:

NCCCP Program Improvement Assessment

Agency IC Tracking Number:

0920-0879-20PU

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
Form	none	NCCCP Assessment - word	Attachment C_NCCCP Awardees Data Collection Instrument_Word Version.docx		Yes	Yes	Fillable Fileable
Form	none	NCCCP Assessment	Attachment D_NCCCP Awardees Data Collection Instrument_Web Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 67

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	67	67
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Awarded jurisdictions	Attachment A_Awarded Jurisdictions.docx	06/23/2020
Letters for fiscal agents	Attachment B_Letters for Bona Fide Fiscal Agents.pdf	06/23/2020
Introductory email	Attachment E_Introductory Email.docx	06/23/2020
Invitation email	Attachment F_Invitation Email.docx	06/23/2020
Reminder email	Attachment G_Reminder Email.docx	06/23/2020
Thank you email	Attachment H _Thank You Email.docx	06/23/2020
Supporting statement A	NCCCP-EVAL-SSA.docx	06/23/2020
Supporting statement B	NCCCP-EVAL-SSB.docx	06/23/2020

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