Information Collection

Collaborative Assessment Tool (THRIVE Partners)

IC 224631 under ICR 201801-0920-001 · OMB 0920-1178.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1178 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CAT screenshots Collaborative Assessment Tool (THRIVE Partners)	Form
Attachment 6 Collaborative Assessment Tool 11 22 2016 final.docx	Instruction
Att 6 Collaborative Assessment Tool original.docx	Instruction
CAT screenshots Att 8 THRIVE_CAT_screenshots.docx	Form

IC Title:

Collaborative Assessment Tool (THRIVE Partners)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	690	690

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.

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