Information Collection

Publilc Health Action Report - Existing Awardees

IC 222652 under ICR 202306-0920-006 · OMB 0920-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1175 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1175 Publilc Health Action Report - Existing Awardees	Form and Instruction
0920-1175 Program Accomplishments & Public Health Actions Att5D Program Accomplish-PHealth Actions - (RedCap Form).pdf	Form and Instruction
0920-1175 Program Accomplishments & Public Health Actions Att5D Program Accomplish-PHealth Actions - (RedCap Form).pdf	Form and Instruction
Att5C Program Accomplish-PH Actions.pdf Program Accomplishments & Public Health Actiuons	IC Document
Att5C Program Accomplish-PH Actions.pdf Program Accomplishments & Public Health Actiuons	IC Document

IC Title:

Publilc Health Action Report - Existing Awardees

Agency IC Tracking Number:

0920-1175

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	0920-1175	Program Accomplishments & Public Health Actions	Att5D Program Accomplish-PHealth Actions - (RedCap Form).pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37

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	74	-46	120
Annual IC Time Burden (Hours)	1,480	-920	2,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Program Accomplishments & Public Health Actiuons	Att5C Program Accomplish-PH Actions.pdf	06/09/2023

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