Evaluation Work Plan Template

[CPR] Workplan Templates for Ten Regional Centers to Enhance Public Health Preparedness and Response

Documents and Forms

Document Name Document Type
Form 0920-24EZ Evaluation Work Plan Template Form
0920-24EZ Evaluation Work Plan Template Att4 - Evaluation Workplan Template.docx Form
0920-24EZ Evaluation Work Plan Template Att4 - Evaluation Workplan Template.docx Form

Information Collection (IC) Details

IC Title:	Evaluation Work Plan Template	Agency IC Tracking Number:	0920-24EZ

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR U.S.C. 247D-6 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-24EZ	Evaluation Work Plan Template	Att4 - Evaluation Workplan Template.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	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.