Annual Progress Report

Performance Monitoring of CDC’s Core State Injury Prevention Program

Documents and Forms

Document Name Document Type
Form 0920 Annual Progress Report Form and Instruction
0920 Core SIPP Annual Progress Report Attachment D_Core SIPP Partners Portal reporting template.pdf Form and Instruction
Attachment D1_Partners Portal sreenshoots.pptx Partners' Partners' Portal (screenshots) IC Document

Information Collection (IC) Details

IC Title:	Annual Progress Report	Agency IC Tracking Number:	0920-21FJ

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	Core SIPP Annual Progress Report	Attachment D_Core SIPP Partners Portal reporting template.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	253	253
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Partners' Partners' Portal (screenshots)	Attachment D1_Partners Portal sreenshoots.pptx	12/22/2021

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