Recipient-Led Evaluation Annual Report Template

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

OMB: 0920-1311

IC ID: 241434

Information Collection (IC) Details

View Information Collection (IC)

Recipient-Led Evaluation Annual Report Template
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Recipient Evalation Year 3 Effectiveness Brief Att 6c. Cat B Rec Eval Annual Report Temp Y3.docx Yes Yes Fillable Fileable
Form and Instruction n/a Recipient Evaluation Year 4 Sustainability and Action Report Guidance Att 6d.Cat B Rec Eval Annual Report Temp Y4.docx Yes Yes Fillable Fileable
Form and Instruction n/a Recipient Evaluation Year 5 Health Impact Statement Att 6e.Cat B Rec Eval Annual Report Temp Y5 .docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

51 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 51 0 51 0 0 0
Annual IC Time Burden (Hours) 408 0 408 0 0 0
Annual IC Cost Burden (Dollars) 14,688 0 14,688 0 0 0

Title Document Date Uploaded
Year 1 Implementation Brief Att 6a. Cat Rec Eval Annual Report Temp Y1.docx 05/05/2020
Year 2 Efficiency Improvement Plan and Process Model Att 6b.Cat B Rec Eval Annual Report Temp Y2.docx 05/05/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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