Information Collection

Lead Evaluator Survey INTRODUCTION

IC 265751 under ICR 202507-0920-011 · OMB 0920-1431.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24AA Lead Evaluator Survey INTRODUCTION	Form and Instruction
Form 0920-24AA Lead Evaluator Survey Lead Evaluator Survey INTRODUCTION	Form and Instruction
0920-24AA Lead Evaluator Survey Att. 5 Lead Evaluator Survey clean.docx	Form and Instruction
0920-24AA Lead Evaluator Survey Att. 5 Lead Evaluator Survey clean.docx	Form and Instruction
Att. 5a Lead Evaluator Survey Screenshots.pdf RPE Lead Evaluator Survey Screenshots	IC Document
Att. 5a Lead Evaluator Survey Screenshots.pdf RPE Lead Evaluator Survey Screenshots	IC Document

IC Title:

Agency IC Tracking Number:

0920-24AA

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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 and Instruction	0920-24AA				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 128

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	Previously Approved
Annual Number of Responses for this IC	128	128
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RPE Lead Evaluator Survey Screenshots		03/04/2024

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

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