Information Collection

Awardee Lead Profile Assessment (ALPA) Web Survey

IC 228696 under ICR 202604-0920-004 · OMB 0920-1215.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Awardee Lead Profile Assessment (ALPA) (web survey screenshots) Awardee Lead Profile Assessment (ALPA) Web Survey	Form and Instruction
Awardee Lead Profile Assessment (ALPA) (web survey scree Attachment 4 ALPA REDCap Screenshots.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0186

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 and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	75	0	75
Annual IC Time Burden (Hours)	66	7	59
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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