Recipient Information

Preventive Health and Health Services Block Grant

OMB: 0920-0106

IC ID: 243520

Information Collection (IC) Details

View Information Collection (IC)

Recipient Information
 
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 none Recipient Information Instruments Att D_Recipient Information Instruments_050120.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

61 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 61 0 61 0 0 0
Annual IC Time Burden (Hours) 122 0 122 0 0 0
Annual IC Cost Burden (Dollars) 4,204 0 4,204 0 0 0

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

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