Evaluation and Performance Measuring Plan Template

[NCIPC] Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement

Documents and Forms

Document Name Document Type
Form 0920-1283 Evaluation and Performance Measuring Plan Template Form and Instruction
0920-1283 Evaluation and Performance Measuring Plan Template - Ann Attachment 3a_Evaluation and Performance Measuring Plan Template - Annual Reporting.docx Form and Instruction
0920-1283 Evaluation and Performance Measuring Plan Template - Ann Attachment 3a_Evaluation and Performance Measuring Plan Template - Annual Reporting.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation and Performance Measuring Plan Template	Agency IC Tracking Number:	0920-1283

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1283	Evaluation and Performance Measuring Plan Template - Annual Reporting	Attachment 3a_Evaluation and Performance Measuring Plan Template - Annual Reporting.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 66	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	Previously Approved
Annual Number of Responses for this IC	66	44	22
Annual IC Time Burden (Hours)	264	0	264
Annual IC Cost Burden (Dollars)	0	-8,800	8,800

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.