Coverdell- Cost Collection Tool (Program Manager)

[NCCDPHP] Paul Coverdell National Acute Stroke Program (2015-2020) Assessment

Documents and Forms

Document Name Document Type
Form 0920-1233 Coverdell- Cost Collection Tool (Program Manager) Form and Instruction
0920-1233 Coverdell Cost Collection Tool A2-B3. Coverdell Cost Collection Tool_08-12-22.xlsx Form and Instruction
0920-1233 Coverdell Cost Collection Tool A2-B3. Coverdell Cost Collection Tool_08-12-22.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Coverdell- Cost Collection Tool (Program Manager)	Agency IC Tracking Number:	0920-1233

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	0920-1233	Coverdell Cost Collection Tool	A2-B3. Coverdell Cost Collection Tool_08-12-22.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	39	39
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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