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Application Form
Million Hearts Hypertension Control Challenge
OMB: 0920-0976
IC ID: 206920
OMB.report
HHS/CDC
OMB 0920-0976
ICR 202106-0920-016
IC 206920
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0976 can be found here:
2022-10-19 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0976
Application Form
Form and Instruction
0920-0976 Application Form
Attachment 3a. Revised Application Form 0920-0976.docx
Form and Instruction
0920-0976 Application Form
Attachment 3a. Revised Application Form 0920-0976.docx
Form and Instruction
Attachment 3b. Confirmation email 0920-0976.docx
Confirmation Email
IC Document
Attachment 3b. Confirmation email 0920-0976.docx
Confirmation Email
IC Document
Attachment 6 Screenshot 2019 Challenge 0920-0976.pdf
Screenshots of Updated 2016 Web site
IC Document
Attachment 6 Screenshot 2019 Challenge 0920-0976.pdf
Screenshots of Updated 2016 Web site
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application Form
Agency IC Tracking Number:
0920-0976
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-0976
Application Form
Attachment 3a. Revised Application Form 0920-0976.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
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
200
0
0
0
0
200
Annual IC Time Burden (Hours)
100
0
0
0
0
100
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Confirmation Email
Attachment 3b. Confirmation email 0920-0976.docx
07/25/2019
Screenshots of Updated 2016 Web site
Attachment 6 Screenshot 2019 Challenge 0920-0976.pdf
07/25/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.