Information Collection

Public Health AmeriCorps Grantee Survey

IC 260453 under ICR 202303-3045-002 · OMB 3045-0137.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0137 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Public Health AmeriCorps Grantee Survey	Form and Instruction
1 Public Health AmeriCorps Grantee Survey PublicHealthAmeriCorps grantee survey instrument_5.20.23 OMB.docx www.americorps.gov	Form and Instruction
Generic Clearance Submission_PHA Evaluation_Grantee Survey_.docx Public Health AmeriCorps Grantee Survey	IC Document

IC Title:

Public Health AmeriCorps Grantee Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 12501

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	1	Public Health AmeriCorps Grantee Survey	PublicHealthAmeriCorps grantee survey 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: 82

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	82	82
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Public Health AmeriCorps Grantee Survey	Generic Clearance Submission_PHA Evaluation_Grantee Survey_.docx	05/30/2023

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