Information Collection

NBCCEDP Service Delivery Projection Worksheet

IC 250027 under ICR 202501-0920-002 · OMB 0920-1046.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1046 NBCCEDP Service Delivery Projection Worksheet	Form and Instruction
Form 0920-1046 NBCCEDP Service Delivery Projections NBCCEDP Service Delivery Projection Worksheet	Form and Instruction
0920-1046 NBCCEDP Service Delivery Projections Att 8 - NBCCEDP Service Delivery Projection Worksheet.xlsx	Form and Instruction
0920-1046 NBCCEDP Service Delivery Projections Att 8 - NBCCEDP Service Delivery Projection Worksheet_rev 03-17-25.xlsx	Form and Instruction
Att 8a - NBCCEDP Service Delivery Projection Worksheet (screenshots).docx NBCCEDP Service Delivery Projections (screenshots)	IC Document
Att 8a - NBCCEDP Service Delivery Projection Worksheet (screenshots).docx NBCCEDP Service Delivery Projections (screenshots)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1046

Is this a Common Form? No

IC Status: Modified

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	0920-1046				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 71

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	Previously Approved
Annual Number of Responses for this IC	71	1	70
Annual IC Time Burden (Hours)	34	0	34
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NBCCEDP Service Delivery Projections (screenshots)		01/08/2025

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

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