Information Collection

Att. 3f_Partnership Activities Form

IC 222052 under ICR 202012-0920-011 · OMB 0920-1161.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1161 Att. 3f_Partnership Activities Form	Form
0920-1161 Partnership Activities Form Att 3f Partnership Activities Form.docx	Form

IC Title:

Agency IC Tracking Number:

16LL

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	0920-1161	Partnership Activities Form	Att 3f Partnership Activities Form.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

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.