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Federal forms, ICRs, and supporting documents

Information Collection

Preventive Health and Health Services Block Grant Assessment

IC 234732 under ICR 202506-0920-016 · OMB 0920-1257.

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Information Collection (IC) Details

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Preventive Health and Health Services Block Grant Assessment 0920-1257
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1257 Instrument_WORD Att 4_Instrument_Word.docx Yes Yes Fillable Fileable
Form 0920-1257 Instrument_WEB Att 5_Instrument_ Web version.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

41 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 41 0 -20 0 0 61
Annual IC Time Burden (Hours) 31 0 -15 0 0 46
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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