Information Collection

[OADPS] Performance Measures Reporting for OD2A in States Cooperative Agreement

IC 270420 under ICR 202507-0920-006 · OMB 0920-1282.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1282 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0128 [OADPS] Performance Measures Reporting for OD2A in States Cooperative Agreement	Form
Form 0920-25-0128 AttA_OD2AS_PM Technical Guidance_ 2025 May [OADPS] Performance Measures Reporting for OD2A in States Cooperative Agreement	Form
Form 0920-25-0128 OD2A-S Performance Measures Reporting Tool [OADPS] Performance Measures Reporting for OD2A in States Cooperative Agreement	Form and Instruction
AttC_OD2AS Performance Measures_Quick Reference Guide for Qualitative Data_May 2025.pdf	Instruction
AttC_OD2AS Performance Measures_Quick Reference Guide for Qualitative Data_May 2025.pdf	Instruction
0920-25-0128 AttA_OD2AS_PM Technical Guidance_ 2025 May AttA_OD2AS_PM Technical Guidance_ 2025 May.docx	Form
0920-25-0128 AttA_OD2AS_PM Technical Guidance_ 2025 May AttA_OD2AS_PM Technical Guidance_ 2025 May.docx	Form
0920-25-0128 OD2A-S Performance Measures Reporting Tool AttB_OD2A-STATE_Excel Reporting Tool.xlsx	Form and Instruction
0920-25-0128 OD2A-S Performance Measures Reporting Tool AttB_OD2A-STATE_Excel Reporting Tool.xlsx	Form and Instruction
PEO GenIC Request _OD2A-STATE.pdf genIC (24IM) Performance Measures Project Request for genIC Approval (for data collection in 2023, 2024, 2025)	IC Document
PEO GenIC Request _OD2A-STATE.pdf genIC (24IM) Performance Measures Project Request for genIC Approval (for data collection in 2023, 2024, 2025)	IC Document
OD2A_STATE email notification.docx OD2A_STATE email notification	IC Document
OD2A_STATE email notification.docx OD2A_STATE email notification	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[OADPS] Performance Measures Reporting for OD2A in States Cooperative Agreement

Agency IC Tracking Number:

0920-25-0128

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25-0128	Yes	No	Printable Only
Form and Instruction	0920-25-0128	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	50	50
Annual IC Time Burden (Hours)	1,750	0	1,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
genIC (24IM) Performance Measures Project Request for genIC Approval (for data collection in 2023, 2024, 2025)		08/27/2024
OD2A_STATE email notification		08/28/2024

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

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