Information Collection

Partner Program Manager - Cost Resource and Utilization Tool

IC 231172 under ICR 201804-0920-010 · OMB 0920-1233.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1233 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Partner Program Manager - Cost Resource and Utilization Tool	Form and Instruction
Cost Resource and Utilization Tool A2. Screenshots of Partner Cost Collection Tool_1.5.2018.docx	Form and Instruction

IC Title:

Partner Program Manager - Cost Resource and Utilization Tool

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	NA	Cost Resource and Utilization Tool	A2. Screenshots of Partner Cost Collection Tool_1.5.2018.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 137

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	137	137
Annual IC Time Burden (Hours)	274	274
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.