Information Collection

Collaborative Assessment Tool (THRIVE Partners)

IC 224631 under ICR 201911-0920-006 · OMB 0920-1178.

Documents and Forms

Document Name Document Type
Att 6_Annual Collaborative Assessment Tool.docx Instruction
Att 11_THRIVE_CAT_screenshots.docx Other-screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collaborative Assessment Tool (THRIVE Partners)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Instruction			Att 6_Annual Collaborative Assessment Tool.docx		Yes	Yes	Fillable Fileable
Other-screenshots			Att 11_THRIVE_CAT_screenshots.docx		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 %

	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

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.