Evaluability Assessment Nomination Form_WW (Attachment 3b)

[NCCHPHP] Comprehensive Evaluations of the WISEWOMAN Programs, The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program

Documents and Forms

Document Name Document Type
Form 0920-1453 Evaluability Assessment Nomination Form_WW (Attachment 3b) Form and Instruction
Form 0920-1453 Evaluability Assessment Nomination Form_WW (Attachment 3b) Form and Instruction
0920-1453 Att 3b. Evaluability Assessment Nomination Form_WW_rev 2 Att 3b. Evaluability Assessment Nomination Form_WW_clean.docx Form and Instruction
0920-1453 Att 3b. Evaluability Assessment Nomination Form_WW_rev 2 Att 3b. Evaluability Assessment Nomination Form_WW_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluability Assessment Nomination Form_WW (Attachment 3b)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-1453	Att 3b. Evaluability Assessment Nomination Form_WW_rev 2025	Att 3b. Evaluability Assessment Nomination Form_WW_clean.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	6	6
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.