Grantee Survey

Evaluation of Public Health AmeriCorps

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 02 Grantee Survey Form and Instruction
02 Grantee Survey 02-Grantee Survey.docx eGrants.gov Form and Instruction
02 Grantee Survey 02-Grantee Survey.docx eGrants.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Grantee Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	02	Grantee Survey	02-Grantee Survey.docx	eGrants.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 82	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	82	82
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	1,942	1,942

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.