0920-1132 Health Impact Statement Template

Performance Progress and Monitoring Report

Att. 1e Health Impact Statement Template

OMB: 0920-1132

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OMB Control No: 0920-1132

Expiration Date: XX/XX/XXXX

Insert Org. Logo here

Insert name of intervention/strategy



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  1. Problem

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  1. Use this space for a graphic or to call out important text











































  1. Intervention





























  1. Health Impact































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* Testimonial/anecdotal information is optional



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPatterson, Keshia
File Modified0000-00-00
File Created2023-08-30
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