Information Collection

REACH Lark Galloway-Gilliam Nomination for Advancing Health Equity (REACH Lark Award)

IC 250818 under ICR 202205-0990-001 · OMB 0990-0390.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0390 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0390 REACH Lark Galloway-Gilliam Nomination for Advancing Health Equity (REACH Lark Award)	Form and Instruction
0990-0390 2022 REACH Lark Award Application 12_1_2021_0990-0390 REACH Lark Award Application_QUESTIONNAIRE.docx	Form and Instruction
0990-0390 2022 REACH Lark Award Application 12_1_2021_0990-0390 REACH Lark Award Application_QUESTIONNAIRE.docx	Form and Instruction
Revised 0990-0390 Lark Award Generic HHS Clearance Request.docx 0990-0390 GenIC Request Template	IC Document
Revised 0990-0390 Lark Award Generic HHS Clearance Request.docx 0990-0390 GenIC Request Template	IC Document
10.28_2021_Full Posting Challenge.gov_OMB Draft_.docx Full Posting Challenge.gov Template	IC Document
10.28_2021_Full Posting Challenge.gov_OMB Draft_.docx Full Posting Challenge.gov Template	IC Document
REACH_LARK Award Challenge FRN.docx REACH Lark Award FRN	IC Document
REACH_LARK Award Challenge FRN.docx REACH Lark Award FRN	IC Document

IC Title:

REACH Lark Galloway-Gilliam Nomination for Advancing Health Equity (REACH Lark Award)

Agency IC Tracking Number:

0990-0390

IC Status: Unchanged

Obligation to Respond: Voluntary

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	0990-0390	2022 REACH Lark Award Application	12_1_2021_0990-0390 REACH Lark Award Application_QUESTIONNAIRE.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-0390 GenIC Request Template	Revised 0990-0390 Lark Award Generic HHS Clearance Request.docx	12/16/2021
Full Posting Challenge.gov Template	10.28_2021_Full Posting Challenge.gov_OMB Draft_.docx	12/16/2021
REACH Lark Award FRN	REACH_LARK Award Challenge FRN.docx	12/16/2021

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