Work Plan Program Questions

[PHIC] Preventive Health and Health Services Block Grant

Documents and Forms

Document Name Document Type
Work Plan Program Questions Form and Instruction
Workplan Program Quesions Att E_Workplan Program Questions (Word Version).docx Form and Instruction
Workplan Program Quesions Att E_Workplan Program Questions (Word Version).docx Form and Instruction
Att F_Workplan Program Questions Screenshots_final.docx Workplan Program Quesions (screenshot) IC Document
Att F_Workplan Program Questions Screenshots_final.docx Workplan Program Quesions (screenshot) IC Document

Information Collection (IC) Details

IC Title:	Work Plan Program Questions	Agency IC Tracking Number:	0920-0106

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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	n/a	Workplan Program Quesions	Att E_Workplan Program Questions (Word Version).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	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	61	61
Annual IC Time Burden (Hours)	610	610
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Workplan Program Quesions (screenshot)	Att F_Workplan Program Questions Screenshots_final.docx	01/29/2024

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