Information Collection

Awardee Lead Profile Assessment (ALPA) Email Survey (MS WORD)

IC 244285 under ICR 202206-0920-003 · OMB 0920-1215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1215 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1215 Awardee Lead Profile Assessment (ALPA) Email Survey (MS WORD)	Form and Instruction
0920-1215 Awardee Lead Profile Assessment (ALPH) Email Survey (MS Att4b ALPA_Email Survey_20220527.docx	Form and Instruction
0920-1215 Awardee Lead Profile Assessment (ALPH) Email Survey (MS Att4b ALPA_Email Survey_20220527.docx	Form and Instruction
Att4c ALPA Training Manual_20220527.docx ALPA Training Manual_20220527	IC Document
Att4c ALPA Training Manual_20220527.docx ALPA Training Manual_20220527	IC Document

IC Title:

Awardee Lead Profile Assessment (ALPA) Email Survey (MS WORD)

Agency IC Tracking Number:

0920-1215

Is this a Common Form? No

IC Status: Modified

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	0920-1215	Awardee Lead Profile Assessment (ALPH) Email Survey (MS WORD)	Att4b ALPA_Email Survey_20220527.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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
	Requested	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ALPA Training Manual_20220527	Att4c ALPA Training Manual_20220527.docx	06/03/2022

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