Information Collection

[NCHHSTP_OPPE] Performance Measurement for STD PCHD (2026-2028)

IC 281609 under ICR 202607-0920-006 · OMB 0920-1282.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
STD PCHD PM Data Collection Tool [NCHHSTP_OPPE] Performance Measurement for STD PCHD (2026-2028)	Form and Instruction
Congenital Syphilis PoC Testing Supplement [NCHHSTP_OPPE] Performance Measurement for STD PCHD (2026-2028)	Form and Instruction
STD PCHD PM Data Collection Tool Att_1_STD PCHD PM Data Collection Tool July 2025.xlsx	Form and Instruction
Congenital Syphilis PoC Testing Supplement Att 4_STDPCHD_CSSupp_DataCollectionTool_June 2026.xlsx	Form and Instruction
PPEO GenIC Template_PS19-1901 STD PCHD_CleanRevision.docx GenIC Template	IC Document
Att_2_STD PCHD PM Reference Guidance July 2025_final.docx Reference Guidance	IC Document
Att 3_PCHD Notification Email.docx Notification Email	IC Document
STD PCHD Project Determination.pdf Research Determination	IC Document
Att 5_STDPCHD_CSSupp_Reference Guide_June 2026.docx Supplementary Reference Guide	IC Document

IC Title:

Agency IC Tracking Number:

0920-26-0245

IC Status: New

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
Form and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

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
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	1,947	1,947
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Template		07/21/2026
Reference Guidance		07/21/2026
Notification Email		07/21/2026
Research Determination		07/21/2026
Supplementary Reference Guide		07/21/2026

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

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