Public Health AmeriCorps Grantee Focus Group

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form 1 Public Health AmeriCorps Grantee Focus Group Form and Instruction
1 PHA Focus Group PublicHealthAmeriCorps grantee focus group instrument_5.20.23 OMB.docx www.americorps.gov Form and Instruction
Generic Clearance Submission_PHA Evaluation_Grantee Focus Group.docx Public Health AmeriCorps Grantee Focus Group IC Document

Information Collection (IC) Details

IC Title:	Public Health AmeriCorps Grantee Focus Group	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 12501

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PHA Focus Group	PublicHealthAmeriCorps grantee focus group instrument_5.20.23 OMB.docx	www.americorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Public Health AmeriCorps Grantee Focus Group	Generic Clearance Submission_PHA Evaluation_Grantee Focus Group.docx	05/30/2023

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