Information Collection

Refugee Health Promotion Data Indicators

IC 238821 under ICR 202112-0970-004 · OMB 0970-0490.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0490 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Refugee Health Promotion Data Indicators	Form
RHP Data Indicator Form User Guide.pdf	Instruction
RHP Data Indicator Form User Guide.pdf	Instruction
1 RHP Program Data Indicators Form RHP Program Data Indicators Form.pdf	Form
1 RHP Program Data Indicators Form RHP Program Data Indicators Form.pdf	Form
RHP_Template for PPR Gen IC.doc Generic PPR Submission Form - RHP Program Data Indicators	IC Document
RHP_Template for PPR Gen IC.doc Generic PPR Submission Form - RHP Program Data Indicators	IC Document
NOA - ORR RHP Data Indicators_0970-0490_1.31.2018.pdf NOA - RHP Data Indicators	IC Document
NOA - ORR RHP Data Indicators_0970-0490_1.31.2018.pdf NOA - RHP Data Indicators	IC Document

IC Title:

Refugee Health Promotion Data Indicators

Agency IC Tracking Number:

ORR

IC Status: Unchanged

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	1	RHP Program Data Indicators Form	RHP Program Data Indicators Form.pdf		Yes	Yes	Fillable Fileable
Instruction			RHP Data Indicator Form User Guide.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	123	123
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic PPR Submission Form - RHP Program Data Indicators	RHP_Template for PPR Gen IC.doc	12/09/2019
NOA - RHP Data Indicators	NOA - ORR RHP Data Indicators_0970-0490_1.31.2018.pdf	12/09/2019

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