Information Collection

Performance Measures- Unique

IC 241554 under ICR 202503-0920-007 · OMB 0920-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1175 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1175 Performance Measures- Unique	Form and Instruction
Form 0920-1175 Performance Measurses - Unique Performance Measures- Unique	Form and Instruction
0920-1175 Performance Measurses - Unique Att5F Performance Measures (RedCap Form).pdf	Form and Instruction
0920-1175 Performance Measurses - Unique Att5F Performance Measures (RedCap Form).pdf	Form and Instruction
Att5E Performance Measures Report.pdf Performance Measures - Unique	IC Document
Att5E Performance Measures Report.pdf Performance Measures - Unique	IC Document

IC Title:

Performance Measures- Unique

Agency IC Tracking Number:

0920-1175

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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	0920-1175				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	Previously Approved
Annual Number of Responses for this IC	37	37
Annual IC Time Burden (Hours)	740	740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Performance Measures - Unique		06/09/2023

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

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