Grantee-Level Outcomes Module

Strategic Prevention Framework for Prescription Drugs (SPF-Rx)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0377 can be found here:

Documents and Forms

Document Name Document Type
Form Grantee-Level Outc Grantee-Level Outcomes Module Form and Instruction
Grantee-Level Outc Grantee-Level Outcomes Attachment 2_SPF-Rx Grantee-Level Outcomes_Module_11.21.19.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Grantee-Level Outcomes Module	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	Grantee-Level Outcomes	Grantee-Level Outcomes	Attachment 2_SPF-Rx Grantee-Level Outcomes_Module_11.21.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	143	143
Annual IC Cost Burden (Dollars)	0	0

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.