Information Collection

BHW Performance Measures Forms

IC 206385 under ICR 202603-0906-004 · OMB 0906-0086.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Performance Measures BHW Performance Measures Forms	Form and Instruction
Form 2 Performance Measures BHW Performance Measures Forms	Form and Instruction
Form 1 Progress Report BHW Performance Measures Forms	Form and Instruction
Form 1 Progress Report BHW Performance Measures Forms	Form and Instruction
Appendix C - Program Mapping Document.docx	Other-Program Mapping Document
0906-0086_Appendix C - Mapping Document - BHW Updates - 4.17.26.docx	Other-Program Mapping Document
2 Performance Measures Appendix C - Performance Measures.docx	Form and Instruction
2 Performance Measures 0906-0086_Appendix C - Performance Measures - BHW Updates - 4.17.26.docx	Form and Instruction
1 Progress Report Appendix B - Progress Report.docx	Form and Instruction
1 Progress Report Appendix B - Progress Report.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Yes	Yes	Fillable Fileable
Other-Program Mapping Document		Yes	Yes	Fillable Fileable
Form and Instruction	1	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,968

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	1,968	86	1,882
Annual IC Time Burden (Hours)	5,657	-272	5,929
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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