Performance Measurement for STD Prevention (NCHHSTP, 2020-2022)

Performance Measures Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1282 can be found here:

Documents and Forms

Document Name Document Type
Performance Measurement for STD Prevention (NCHHSTP, 2020-2022) Form
STD PCHD Performance Measurement Tool Att 1_Data Collection Tool_02242020.xlsx Form
PPEO GenIC Template- PS19-1901 STD PCHD_02242020.docx Template with Project Description IC Document
Att 2_Notification Email.v2.docx Notification Email IC Document
Att 3 STD PCHD Overview and Logic Model.pdf STD PCHD Overview and Logic Model IC Document

Information Collection (IC) Details

IC Title:	Performance Measurement for STD Prevention (NCHHSTP, 2020-2022)	Agency IC Tracking Number:	0920-20KO

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	STD PCHD Performance Measurement Tool	Att 1_Data Collection Tool_02242020.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	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	177	177
Annual IC Time Burden (Hours)	5,310	5,310
Annual IC Cost Burden (Dollars)	193,231	193,231

Documents for IC

Title	Document	Date Uploaded
Template with Project Description	PPEO GenIC Template- PS19-1901 STD PCHD_02242020.docx	02/24/2020
Notification Email	Att 2_Notification Email.v2.docx	02/24/2020
STD PCHD Overview and Logic Model	Att 3 STD PCHD Overview and Logic Model.pdf	02/24/2020

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