Annual Progress Report (subset of Interim Progress questions)

[PHIC] Preventive Health and Health Services Block Grant

Documents and Forms

Document Name Document Type
Annual Progress Report (subset of Interim Progress questions) Form and Instruction
Annual Progress Report Worksheet Att G_Annual Progress Report Worksheet (Word Version).docx Form and Instruction
Annual Progress Report Worksheet Att G_Annual Progress Report Worksheet (Word Version).docx Form and Instruction
Att H_Annual Progress Report Screenshots.docx Annual Progress Report (screenshot) IC Document
Att H_Annual Progress Report Screenshots.docx Annual Progress Report (screenshot) IC Document

Information Collection (IC) Details

IC Title:	Annual Progress Report (subset of Interim Progress 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	Annual Progress Report Worksheet	Att G_Annual Progress Report Worksheet (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)	427	427
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual Progress Report (screenshot)	Att H_Annual Progress Report Screenshots.docx	01/29/2024

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