OMB control number

[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION

OMB 0920-1412 · HHS/CDC.

OMB 0920-1412

The purpose of this data collection is to collect monitoring data project performance and implementation of cooperative agreement for Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Achieving Health Equity through Addressing Disparities (AHEAD). Information collected from recipients on state- and local-level will provide crucial data for performance monitoring of the cooperative agreement and will provide CDC with the capacity to respond in a timely manner to requests for information about the program from the Department of Health and Human Services (HHS), the White House, Congress, and other sources. Recipients will report progress and activity information to CDC on an annual schedule using a web-based Partners’ Portal and web-based survey tool. This Non-Substantive Change Request is submitted to make updates to questions used in OMB 0920-1412 - DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUTATION to be in accordance with EO 14168 & EO 14151. There is a net decrease of 5 burden hours.

The latest form for [NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION expires 2026-08-31 and is listed under ICR 202507-0920-009.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1412 Prevention Infrastructure Assessment Tool - 11JUL2025	Form and Instruction
Form 0920-23AA Att. 5a Prevention Infrastructure Assessment Tool Updated	Form and Instruction
Form 0920-1412 Key Informant Interview Protocol - Evaluator - 11JUL2025	Form and Instruction
Form 0920-23AA Att. 4b Key Informant Interview Protocol - Evaluator	Form and Instruction
Form 0920-1412 Key Informant Interview Protocol - Project Lead - 11JUL2025	Form and Instruction
Form 0920-23AA Att. 4a Key Informant Interview Protocol - Project Lead	Form and Instruction
Form 0920-26-0119 Annual Performance Report	Form and Instruction
Att. 5 PIA 0920-1412 DELTA.pdf	Supplementary Document
Att 2b DELTA_Comment_ response.pdf	Public Comments
Att. 4 DELTA Research Determination.pdf	Supplementary Document
Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf	Supplementary Document
Change Request Memo - 0920-1412.docx	Justification for No Material/Nonsubstantive Change
Att. 5b Prevention Infrastructure Assessment Screenshots Updated.pdf	Supplementary Document
Att. 3b DELTA AHEAD APR Screenshots.docx.pdf	Supplementary Document
Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf	Supplementary Document
SSA - 0920-1412 DELTA final.docx	Supporting Statement A
SSB 0920-1412 DELTA.docx	Supporting Statement B
Prevention Infrastructure Assessment	Form and Instruction
Prevention Infrastructure Assessment	Form and Instruction
Key Informant Interview Evaluator	Form and Instruction
Key Informant Interview Evaluator	Form and Instruction
Key Informant Interview – Project Lead	Form and Instruction
Key Informant Interview – Project Lead	Form and Instruction
Annual Performance Report	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202606-0920-012	Revision of a currently approved collection	2026-06-22
202507-0920-009	No material or nonsubstantive change to a currently approved collection	2025-07-11	Approved without change
202305-0920-013	New collection (Request for a new OMB Control Number)	2023-06-13	Approved without change

OMB Details

Annual Performance Report

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form 0920-23AA	Att. 3a APR Tool	Fillable Fileable	Form and instruction
Form 0920-1412	APR Tool - 11JUL2025	N/A	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.