Information Collection

Annual Performance Report (APR) Tool

IC 262771 under ICR 202310-0920-004 · OMB 0920-1425.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1425 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Annual Performance Report (APR) Tool	Form and Instruction
0920- Annual Performance Report (APR) Tool Att. 3 Annual Performance Report (APR) Tool.docx	Form and Instruction
0920- Annual Performance Report (APR) Tool Att. 3 Annual Performance Report (APR) Tool.docx	Form and Instruction
Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf Annual Performance Report (APR) Tool (WORD)	IC Document
Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf Annual Performance Report (APR) Tool (WORD)	IC Document

IC Title:

Annual Performance Report (APR) Tool

Agency IC Tracking Number:

0920-23DT

Is this a Common Form? No

IC Status: New

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-	Annual Performance Report (APR) Tool	Att. 3 Annual Performance Report (APR) Tool.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annual Performance Report (APR) Tool (WORD)	Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf	10/12/2023

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