Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level

National Evaluation of the DP18-1815 Cooperative Agreement Program: Category B, Cardiovascular Disease Prevention and Management

Documents and Forms

Document Name Document Type
Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level Form and Instruction
Resource Use and Cost Inventory Tool Att 5b. Cost Resource Use_Inven Tool CatB_Site.xlsx Form and Instruction
Resource Use and Cost Inventory Tool Att 5b. Cost Resource Use_Inven Tool CatB_Site.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level	Agency IC Tracking Number:

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	n/a	Resource Use and Cost Inventory Tool	Att 5b. Cost Resource Use_Inven Tool CatB_Site.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	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	Previously Approved
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	1,870	1,870

Documents for IC

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.