NCCCP Program Improvement Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.