Information Collection

Evaluation and Performance Measurement Strategy Report

IC 222656 under ICR 201902-0920-014 · OMB 0920-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1175 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evaluation and Performance Measurement Strategy Report	Form and Instruction
Evaluation and Measurement Strategy Report Form Att5e_Evaluation&PMStrategyReport_Form.docx	Form and Instruction

IC Title:

Evaluation and Performance Measurement Strategy Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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	Evaluation and Measurement Strategy Report Form	Att5e_Evaluation&PMStrategyReport_Form.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: 30

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	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	600	600
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.