Information Collection

Componet 2 Reporting and Work Plans

IC 244062 under ICR 202009-0920-014 · OMB 0920-1329.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1329 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 5_Component 1 Workplan final (MM edits) 1-31-20.xlsx	Other-WORD
Att 5_Component 1 Workplan final (MM edits) 1-31-20.xlsx	Other-WORD
Att 6_Component 2 Workplan (3-6-20).xlsx	Other-WORD
Att 6_Component 2 Workplan (3-6-20).xlsx	Other-WORD
Component 3A Work Plan (3-6-20).docx Component 3A Work Plan	IC Document
Component 3A Work Plan (3-6-20).docx Component 3A Work Plan	IC Document
Component 3B Work Plan (3-6-20).docx Component 3B Work Plan	IC Document
Component 3B Work Plan (3-6-20).docx Component 3B Work Plan	IC Document
Component 3C Work Plan (3-6-20).docx Component 3C Work Plan	IC Document
Component 3C Work Plan (3-6-20).docx Component 3C Work Plan	IC Document

IC Title:

Componet 2 Reporting and Work Plans

Agency IC Tracking Number:

0920-20KN

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-WORD			Att 5_Component 1 Workplan final (MM edits) 1-31-20.xlsx		Yes	Yes	Fillable Fileable
Other-WORD			Att 6_Component 2 Workplan (3-6-20).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	1,400	1,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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