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Evaluability Assessment Nomination Form_WW (Attachment 3b)

IC 271477 under ICR 202504-0920-030 · OMB 0920-1453.

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Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Evaluability Assessment Nomination Form_WW (Attachment 3b)
 
No Modified
 
Voluntary
 

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

Health Public Health Monitoring

 

12 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12 0 0 0 0 12
Annual IC Time Burden (Hours) 6 0 0 0 0 6
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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