Information Collection Request
[NCHHSTP] Evaluation of Safe Spaces in CDC-directly funded Community-based Organizations (CBOs)
ICR 202212-0920-002 · OMB 0920-1403 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920- Staff Interview |
Form and Instruction | New | Repair queued |
| Form 0920- Client Survey (Participant) |
Form | New | Repair queued |
| Form 0920 Eligibility Screener |
Form and Instruction | New | Repair queued |
 Privacy Act Checklist.docx |
Supplementary Document | Uploaded 2023-01-06 | Missing upstream |
| Att 1_Section 301 of the Public Health Service Act.docx |
Supplementary Document | Uploaded 2023-01-06 | Missing upstream |
| SS B_121922.docx |
Supporting Statement B | Uploaded 2023-01-06 | Repair queued |
| SS A_121922.docx |
Supporting Statement A | Uploaded 2023-01-06 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 257787 |  Staff Interview |
Form and Instruction | New | |
| 257786 | Client Survey (Participant) |
Form | New | |
| 257785 | Eligibility Screener |
Form and Instruction | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-1403 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | 0920-22IJ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |