Information Collection

Collaborative Assessment Tool (THRIVE Awardees)

IC 224637 under ICR 201911-0920-006 · OMB 0920-1178.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 6_Annual Collaborative Assessment Tool.docx	Instruction
Att 11_THRIVE_CAT_screenshots.docx	Other-screenshots

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
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: 7

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	7	7
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	60	60

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.