Information Collection

(OD2A-S) Annual Performance Report and Work Plan

IC 238169 under ICR 202301-0920-001 · OMB 0920-1283.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1283 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1283 (OD2A-S) Annual Performance Report and Work Plan	Form and Instruction
0920-1283 OD2A-S Annual Performance Measuring Report and Work Plan Attachment 3e_OD2A-S Annual Performance Report and Work Plan.docx	Form and Instruction
0920-1283 OD2A-S Annual Performance Measuring Report and Work Plan Attachment 3e_OD2A-S Annual Performance Report and Work Plan.docx	Form and Instruction

IC Title:

(OD2A-S) Annual Performance Report and Work Plan

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:

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	0920-1283	OD2A-S Annual Performance Measuring Report and Work Plan (OD2A-S)	Attachment 3e_OD2A-S Annual Performance Report and Work Plan.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

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
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	51	-15	66
Annual IC Time Burden (Hours)	17	-247	264
Annual IC Cost Burden (Dollars)	0	-8,802	8,802

Documents for IC

table that charts IC Documents
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.