Information Collection

Program Administration - Program Options and Cost Options (SSP Local Administrator)

IC 238599 under ICR 202309-0920-005 · OMB 0920-1289.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1289 Program Administration - Program Options and Cost Options (SSP Local Administrator)	Form and Instruction
0920-1289 Program Administration - Program Options and Cost Option 2a. Data Collection Form Electronic.docx	Form and Instruction
0920-1289 Program Administration - Program Options and Cost Option 2a. Data Collection Form Electronic.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1289

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	0920-1289	Program Administration - Program Options and Cost Options	2a. Data Collection Form Electronic.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 162

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	162	162
Annual IC Time Burden (Hours)	124	124
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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