Information Collection

Lead Evaluator Survey INTRODUCTION

IC 265751 under ICR 202402-0920-009 · OMB 0920-1431.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1431 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24AA Lead Evaluator Survey INTRODUCTION	Form and Instruction
0920-24AA Lead Evaluator Survey Att. 5 Lead Evaluator Survey.pdf	Form and Instruction
0920-24AA Lead Evaluator Survey Att. 5 Lead Evaluator Survey.pdf	Form and Instruction
Att. 5a Lead Evaluator Survey Screenshots.pdf RPE Lead Evaluator Survey Screenshots	IC Document
Att. 5a Lead Evaluator Survey Screenshots.pdf RPE Lead Evaluator Survey Screenshots	IC Document

IC Title:

Lead Evaluator Survey INTRODUCTION

Agency IC Tracking Number:

0920-24AA

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-24AA	Lead Evaluator Survey	Att. 5 Lead Evaluator Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 128

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	128	128
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RPE Lead Evaluator Survey Screenshots	Att. 5a Lead Evaluator Survey Screenshots.pdf	03/04/2024

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