2019-2024 PRC-PERS Questions

Prevention Research Centers Program Monitoring and Evaluation

Documents and Forms

Document Name Document Type
Attachment5_PERS_ListofQuestions.pdf Other-Web
Attachment5_PERS_ListofQuestions.pdf Other-Web
Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx Att 6_PRC Program Webbased IC Document
Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx Att 6_PRC Program Webbased IC Document

Information Collection (IC) Details

IC Title:	2019-2024 PRC-PERS Questions	Agency IC Tracking Number:	0920-21BG

Is this a Common Form? No		IC Status: New

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
Other-Web			Attachment5_PERS_ListofQuestions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	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 Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 6_PRC Program Webbased	Attachment6_PRCProgramWebbasedDataCollectionSystemScreenshots.docx	07/12/2021

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