Information Collection

Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)

IC 272058 under ICR 202410-0920-005 · OMB 0920-1453.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	Form and Instruction
0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Att 5a. Comprehensive Evaluation_Resource Use and Cost Inventory Tool_Recipients.xlsx	Form and Instruction
0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Att 5a. Comprehensive Evaluation_Resource Use and Cost Inventory Tool_Recipients.xlsx	Form and Instruction

IC Title:

Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)

Agency IC Tracking Number:

0920-24FI

Is this a Common Form? No

IC Status: New

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	0920-24FI	Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)	Att 5a. Comprehensive Evaluation_Resource Use and Cost Inventory Tool_Recipients.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 37

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	37	37
Annual IC Time Burden (Hours)	93	93
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.