Information Collection

Healthy People 2030 Champion Application

IC 252506 under ICR 202407-0990-002 · OMB 0990-0281.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Healthy People 203 Healthy People 2030 Champion Application	Form and Instruction
Healthy People 203 Healthy People 2030 Champion Application Healthy People 2030 Champion Draft Application March 2022.docx	Form and Instruction
HP2030 Champions Application 0990-0281 Supporting Statement A_Template 3.31.docx HP2030 Application Supplement	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

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	Healthy People 2030 Champion Application	Healthy People 2030 Champion Application	Healthy People 2030 Champion Draft Application March 2022.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HP2030 Application Supplement	HP2030 Champions Application 0990-0281 Supporting Statement A_Template 3.31.docx	04/04/2022

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