Information Collection

Annual Program Performance Report

IC 7549 under ICR 202306-0930-003 · OMB 0930-0169.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0169 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PAIMI PPR Annual Program Performance Report	Form and Instruction
PAIMI PPR PAIMI PPR 0169 PAIMI _PPR_ Clean - 5.24.2023.docx	Form and Instruction
PAIMI PPR PAIMI PPR 0169 PAIMI _PPR_ Clean - 5.24.2023.docx	Form and Instruction
PAIMI PPR Instruct PAIMI PPR Instructions 0169 PAIMI _PPR_Instructions_Clean - 5.24.2023.docx	Form and Instruction
PAIMI PPR Instruct PAIMI PPR Instructions 0169 PAIMI _PPR_Instructions_Clean - 5.24.2023.docx	Form and Instruction
0169 PAIMI _PPR_ Mark-up - 5.24.2023.docx 0169 PAIMI _PPR_ Mark-up	IC Document
0169 PAIMI _PPR_ Mark-up - 5.24.2023.docx 0169 PAIMI _PPR_ Mark-up	IC Document
0169 PAIMI _PPR_Instructions_Mark-up - 5.24.2023.docx 0169 PAIMI _PPR Instructions _ Mark-up	IC Document
0169 PAIMI _PPR_Instructions_Mark-up - 5.24.2023.docx 0169 PAIMI _PPR Instructions _ Mark-up	IC Document

IC Title:

Annual Program Performance Report

Agency IC Tracking Number:

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	PAIMI PPR	PAIMI PPR	0169 PAIMI _PPR_ Clean - 5.24.2023.docx		Yes	Yes	Fillable Fileable
Form and Instruction	PAIMI PPR Instructions	PAIMI PPR Instructions	0169 PAIMI _PPR_Instructions_Clean - 5.24.2023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	57	0	57
Annual IC Time Burden (Hours)	1,140	-342	1,482
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0169 PAIMI _PPR_ Mark-up	0169 PAIMI _PPR_ Mark-up - 5.24.2023.docx	06/22/2023
0169 PAIMI _PPR Instructions _ Mark-up	0169 PAIMI _PPR_Instructions_Mark-up - 5.24.2023.docx	06/22/2023

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