Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)

[NCCHPHP] Comprehensive Evaluations of theDP-23-003, DP-23-004, and DP-23-0005 Cooperative Agreement Programs: The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1453 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-24FI Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) Form and Instruction
0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Att 3a. Evaluability Assessment Nomination Form_NCHP_ICHP.docx Form and Instruction
0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Att 3a. Evaluability Assessment Nomination Form_NCHP_ICHP.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	Agency IC Tracking Number:	0920-24FI

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	0920-24FI	In-Depth Assessment – Evaluability Assessment Nomination Form – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Att 3a. Evaluability Assessment Nomination Form_NCHP_ICHP.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	12	12
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.