Information Collection

Annual Progress Report

IC 250897 under ICR 202506-0920-017 · OMB 0920-1369.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1369 Annual Progress Report	Form
Form 0920-1369 Core SIPP Program Annual Progress Report Annual Progress Report	Form
0920-1369 Core SIPP Program Annual Progress Report 0920-1369 Att D_Partners Portal.pdf	Form
0920-1369 Core SIPP Program Annual Progress Report 0920-1369 Att D_Partners Portal.pdf	Form
Attachment D1_Partners Portal sreenshoots.pptx Partners' Partners' Portal (screenshots)	IC Document
Attachment D1_Partners Portal sreenshoots.pptx Partners' Partners' Portal (screenshots)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1369

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	0920-1369				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

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	26	3	23
Annual IC Time Burden (Hours)	286	33	253
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Partners' Partners' Portal (screenshots)		12/22/2021

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

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