Information Collection

BHW Performance Measures Forms

IC 206385 under ICR 202403-0906-004 · OMB 0906-0086.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0086 can be found here:

Documents and Forms

Document Name Document Type
Form 1 BHW Performance Measures Forms Form and Instruction
0915-0061 - Appendix C - Program Mapping Document (updated).pdf Other-Program Mapping Document
1 Performance Metrics 2023.pdf 0915-0061 - Appendix C - Performance Metrics - 2023 (updated).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BHW Performance Measures Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Performance Metrics 2023.pdf	0915-0061 - Appendix C - Performance Metrics - 2023 (updated).pdf		Yes	Yes	Fillable Fileable
Other-Program Mapping Document			0915-0061 - Appendix C - Program Mapping Document (updated).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,882	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,882	252	1,630
Annual IC Time Burden (Hours)	5,929	527	5,402
Annual IC Cost Burden (Dollars)	0	0	0

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.