Information Collection

Annual Progress Report Tool

IC 233035 under ICR 202006-0920-013 · OMB 0920-1247.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1247 Delta Impact Annual Progress Report Tool	Form and Instruction
0920-1247 Delta Impact DELTA Impact Att. 3a APR Tool 5.15.2020 Updated.docx	Form and Instruction
Crosswalk of APR Changes May 14 new format.docx Crosswalk of Changes	IC Document
OMB_Change_Request_DELTA_051520 updated 6_8.docx Chnage Request	IC Document

IC Title:

Agency IC Tracking Number:

0920-20OW

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	0920-1247				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	10	10
Annual IC Time Burden (Hours)	117	117
Annual IC Cost Burden (Dollars)	3,586	3,586

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk of Changes		06/18/2020
Chnage Request		06/18/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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