OMB control number
Promoting Adolescent Health through School-Based HIV Prevention
OMB 0920-1275 · HHS/CDC.
OMB 0920-1275
The purpose of this request is to obtain a three-year approval for data collection using a Web-based program evaluation and monitoring system, the Program Evaluation and Reporting System (PERS), that will use questionnaires to allow the Division of Adolescent and School Health, (DASH) at the Centers for Disease Control and Prevention (CDC) to organize, plan, and track activities conducted by funded Local Education Agencies (LEAs) under NOFO PS18-1807 Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance.
The latest form for Promoting Adolescent Health through School-Based HIV Prevention expires 2022-11-30 and is listed under ICR 201908-0920-010.
Latest Forms, Documents, and Supporting Material
PERS: District Assistance Questionnaire
Att13 PIA.pdf
District Assistance QuestionnaireAll Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202209-0920-014 | Extension without change of a currently approved collection | 2022-09-30 | Approved without change | |
| 201908-0920-010 | New collection (Request for a new OMB Control Number) | 2019-09-11 | Approved with change |
OMB Details
Funded District Questionnaire
Federal Enterprise Architecture: Health - Public Health Monitoring
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form 0920-19AUK | Funded District Questionnaire | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.