Information Collection

Lead Evaluator Survey INTRODUCTION

IC 265751 under ICR 202608-0920-004 · OMB 0920-1431.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0205 RPE Lead Evaluator Survey Lead Evaluator Survey INTRODUCTION	Form
0920-26-0205 RPE Lead Evaluator Survey Att. 4 1431 RPE Lead Evaluator Survey clean.docx	Form
Att. 5a Lead Evaluator Survey Screenshots.pdf RPE Lead Evaluator Survey Screenshots	IC Document

IC Title:

Agency IC Tracking Number:

0920-26-0205

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	0920-26-0205				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

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	53	-75	128
Annual IC Time Burden (Hours)	27	-37	64
Annual IC Cost Burden (Dollars)	0	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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