Information Collection

CRCCP Quarterly Program Update

IC 244537 under ICR 202011-0920-009 · OMB 0920-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CRCCP Quarterly Program Update	Form and Instruction
CRCCP Quarterly Program Update Att 6a - CRCCP Qrtrly Prgm Update (screenshots) FINAL.docx	Form and Instruction
CRCCP Quarterly Program Update Att 6a - CRCCP Qrtrly Prgm Update (screenshots) FINAL.docx	Form and Instruction

IC Title:

CRCCP Quarterly Program Update

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	n/a	CRCCP Quarterly Program Update	Att 6a - CRCCP Qrtrly Prgm Update (screenshots) FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	2,807	2,807

Documents for IC

table that charts IC Documents
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.