Information Collection

[NCHHSTP] Performance Measurement for STD Prevention (carryover to 2023-2025)

IC 258148 under ICR 202412-0920-010 · OMB 0920-1282.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1282 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
STD PCHD Performance Measurement [NCHHSTP] Performance Measurement for STD Prevention (carryover to 2023-2025)	Form and Instruction
STD PCHD Performance Measurement Att 1_Data Collection Tool_02242020.xlsx	Form and Instruction
PPEO GenIC Template_PS19-1901_2023-2025.docx GenIC Request Template STD Prevention PS19-1901 (carryover 2023-2025)	IC Document
Att 2_Notification Email.v2.docx Notification Email	IC Document
Att 3 STD PCHD Overview and Logic Model.pdf Overview and Logic Model for PS19-1901 STD PCHD	IC Document

IC Title:

[NCHHSTP] Performance Measurement for STD Prevention (carryover to 2023-2025)

Agency IC Tracking Number:

0920-20KO

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	None				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 177

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
	Requested	Previously Approved
Annual Number of Responses for this IC	177	177
Annual IC Time Burden (Hours)	5,310	5,310
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template STD Prevention PS19-1901 (carryover 2023-2025)		01/30/2023
Notification Email		01/30/2023
Overview and Logic Model for PS19-1901 STD PCHD		01/30/2023

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

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