Information Collection Request
[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION
ICR 202305-0920-013 · OMB 0920-1412 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1412 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-23AA Health Equity Capacity Assessment |
Form and Instruction | New | Repair queued |
| Form 0920-23AA Prevention Infrastructure Assessment |
Form and Instruction | New | Repair queued |
| Form 0920-23AA Key Informant Interview Evaluator |
Form and Instruction | New | Repair queued |
| Form 0920-23AA Key Informant Interview – Project Lead |
Form and Instruction | New | Repair queued |
| Form 0920-23AA Annual Performance Report |
Form and Instruction | New | Repair queued |
 Att. 5b Prevention Infrastructure Assessment Screenshots Updated.pdf |
Supplementary Document | Uploaded 2023-06-12 | Repair queued |
| Att. 3b DELTA AHEAD APR Screenshots.docx.pdf |
Supplementary Document | Uploaded 2023-06-12 | Repair queued |
| Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf |
Supplementary Document | Uploaded 2023-06-12 | Repair queued |
 SSA - DELTA AHEAD 5.16.23.docx |
Supporting Statement A | Uploaded 2023-06-12 | Repair queued |
| SSB - DELTA AHEAD - 5.16.23.docx |
Supporting Statement B | Uploaded 2023-06-12 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 260627 |  Health Equity Capacity Assessment |
Form and Instruction | New | |
| 260626 | Prevention Infrastructure Assessment |
Form and Instruction | New | |
| 260625 | Key Informant Interview Evaluator |
Form and Instruction | New | |
| 260624 | Key Informant Interview – Project Lead |
Form and Instruction | New | |
| 260623 | Annual Performance Report |
Form and Instruction | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-1412 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | 0920-23AA |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |