Cost Study Resource Use and Cost Study Inventory Tool - Health Departments

National Evaluation of the DP18-1815 Cooperative Agreement Program: Category B, Cardiovascular Disease Prevention and Management

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1311 can be found here:

Documents and Forms

Document Name Document Type
Cost Study Resource Use and Cost Study Inventory Tool - Health Departments Form and Instruction
Resource Use and Cost Inventory Tool Att 5a. Cost Resource Use_Inven Tool CatB_HD.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Cost Study Resource Use and Cost Study Inventory Tool - Health Departments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	n/a	Resource Use and Cost Inventory Tool	Att 5a. Cost Resource Use_Inven Tool CatB_HD.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	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	8	8
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	656	656

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.