Information Collection

Evaluation Work Plan Template

IC 267495 under ICR 202405-0920-003 · OMB 0920-1437.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1437 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.