Information Collection Request

BHW Performance Report for Grants and Cooperative Agreements

ICR 202112-0915-001 · OMB 0915-0061 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Performance Metrics.pdf Form and Instruction Modified Available
Form 1 BHW Performance Measures Forms Form and Instruction Modified Repair queued
Appendix D - 60 day FRN NCHWA Performance Measure 0915-0061 Rev.docx.pdf Supplementary Document Uploaded 2021-12-07 Repair queued
Appendix E - Program Mapping Document.pdf Supplementary Document Uploaded 2021-12-07 Repair queued
0915-0061 - Supporting Statement A_final rev.docx Supporting Statement A Uploaded 2021-12-07 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
206385 BHW Performance Measures Forms Form and Instruction ModifiedPerformance Metrics.pdf
206385 BHW Performance Measures Forms Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2025 36 Months From Approved 03/31/2022
1,630 0 1,500
5,402 0 5,710
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
BHW Performance Measures Forms 1

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,630 1,500 0 130 0 0
Annual Time Burden (Hours) 5,402 5,710 0 -308 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No