Information Collection

Performance Measure Data Report Form (Instrument 4)

IC 223555 under ICR 202012-0970-016 · OMB 0970-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0497 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx	Other-Data Entry Form
Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx	Other-Data Entry Form

IC Title:

Performance Measure Data Report Form (Instrument 4)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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-Data Entry Form			Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 391

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	782	-50	832
Annual IC Time Burden (Hours)	10,989	-1,023	12,012
Annual IC Cost Burden (Dollars)	0	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.