Information Collection

Awardee Lead Profile Assessment (ALPA) Web Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Awardee Lead Profile Assessment (ALPA) Web Survey	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Awardee Lead Profile Assessment (ALPA) (web survey screenshots)	Attachment 4 ALPA REDCap Screenshots.pdf		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 %

	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

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].