Information Collection

NBCCEDP Service Delivery Projection Worksheet

IC 250027 under ICR 202111-0920-005 · OMB 0920-1046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1046 NBCCEDP Service Delivery Projection Worksheet	Form and Instruction
0920-1046 NBCCEDP Service Delivery Projections Att 8 - NBCCEDP Service Delivery Projections Worksheet.xlsx	Form and Instruction
0920-1046 NBCCEDP Service Delivery Projections Att 8 - NBCCEDP Service Delivery Projections Worksheet.xlsx	Form and Instruction
Att 8a - NBCCEDP Service Delivery Projection Worksheet (screenshots).docx NBCCEDP Service Delivery Projections (screenshots)	IC Document
Att 8a - NBCCEDP Service Delivery Projection Worksheet (screenshots).docx NBCCEDP Service Delivery Projections (screenshots)	IC Document

IC Title:

NBCCEDP Service Delivery Projection Worksheet

Agency IC Tracking Number:

0920-1046

Is this a Common Form? No

IC Status: New

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 and Instruction	0920-1046	NBCCEDP Service Delivery Projections	Att 8 - NBCCEDP Service Delivery Projections Worksheet.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NBCCEDP Service Delivery Projections (screenshots)	Att 8a - NBCCEDP Service Delivery Projection Worksheet (screenshots).docx	11/02/2021

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