Information Collection Request

Evaluation of Public Health AmeriCorps

ICR 202311-3045-001 · OMB 3045-0199 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0199 can be found here:

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form 06 Training and TA Form	Form and Instruction	New	Repair queued
Form 02 Grantee Survey	Form and Instruction	New	Repair queued
Form 01 Early Exit Survey	Form and Instruction	New	Repair queued
Form 01 Member Alumni Survey	Form and Instruction	New	Repair queued
30-Day Notice_02-06-24.pdf	Supplementary Document	Uploaded 2024-02-06	Repair queued
60-Day PHA Evaluation.pdf	Supplementary Document	Uploaded 2024-01-29	Missing upstream
42 U.S.C. 12639.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
EO 13996.pdf	Supplementary Document	Uploaded 2024-01-29	Repair queued
3045-NEW PHA Member Outcome Surveys_SSB.docx	Supporting Statement B	Uploaded 2024-01-29	Repair queued
3045-NEW PHA Member outcome Surveys_SSA.docx	Supporting Statement A	Uploaded 2024-01-29	Missing upstream

Information collection document groups
IC ID	Collection	Type	Status
264766	Partner Interview	Other-Interview Questions	New
264765	Early Exit Interview	Other-Interview Questions	New
264764	Grantee Focus Group	Other-Focus Group Questions	New
264741	Training and TA Form	Form and Instruction	New
264740	Grantee Survey	Form and Instruction	New
264739	Early Exit Survey	Form and Instruction	New
264738	Member Alumni Survey	Form and Instruction	New

Record metadata
Status	Received in OIRA
Agency/Subagency	CNCS
OMB Control No	3045-0199
Type of Information Collection	New collection (Request for a new OMB Control Number)
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31