Information Collection

Project Evaluators

IC 178432 under ICR 202311-0930-002 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Document Name Document Type
Form Prevention Strateg Project Evaluators Form and Instruction
Prevention Strateg Prevention Strategies Inventory (PSI) Att B.1 PSI for OMB_clean 7_24_23 final.docx Form and Instruction
Prevention Strateg Prevention Strategies Inventory (PSI) Att B.1 PSI for OMB_clean 7_24_23 final.docx Form and Instruction
Training Activity Training Activity Summary Page (TASP) Att C.1 TASP_for OMB_clean 7_24_23 final.docx Form and Instruction
Training Activity Training Activity Summary Page (TASP) Att C.1 TASP_for OMB_clean 7_24_23 final.docx Form and Instruction
EIRFT-Individual F EIRFT-Individual Form Att G.1 EIRFT-Individual_for OMB_clean 7_24_23 final.docx Form and Instruction
EIRFT-Individual F EIRFT-Individual Form Att G.1 EIRFT-Individual_for OMB_clean 7_24_23 final.docx Form and Instruction
EIRFT-Screening Fo EIRFT-Screening Form Att H.1 EIRFT-Screening_for OMB_clean 7_24_23 final.docx Form and Instruction
EIRFT-Screening Fo EIRFT-Screening Form Att H.1 EIRFT-Screening_for OMB_clean 7_24_23 final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Project Evaluators	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Prevention Strategies Inventory (PSI)	Prevention Strategies Inventory (PSI)	Att B.1 PSI for OMB_clean 7_24_23 final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Training Activity Summary Page (TASP)	Training Activity Summary Page (TASP)	Att C.1 TASP_for OMB_clean 7_24_23 final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	EIRFT-Individual Form	EIRFT-Individual Form	Att G.1 EIRFT-Individual_for OMB_clean 7_24_23 final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	EIRFT-Screening Form	EIRFT-Screening Form	Att H.1 EIRFT-Screening_for OMB_clean 7_24_23 final.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 124	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	682	682
Annual IC Time Burden (Hours)	573	573
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.