OMB control number

[ATSDR] APPLETREE Performance Measures

OMB 0923-0057 · HHS/TSDR.

OMB 0923-0057

Under the APPLETREE cooperative agreement (CDC-RFA-TS17-1701), ATSDR collects information related to Awardee activities and the process and outcome performance measures. Information will be used to monitor progress toward program goals and objectives, and for quality improvement. The revision includes a minor increase in respondents, additional forms, and other minor changes.

The latest form for [ATSDR] APPLETREE Performance Measures expires 2026-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
ATSDR Requests Form Form and Instruction
ATSDR Recommendation Follow-up Form and Instruction
ATSDR SoilSHOPS Form Form and Instruction
CSPECE Quantitative Form Form and Instruction
CSPECE Qualitative Narrative Form Form and Instruction
ATSDR Success Story Form Form and Instruction
APPLETREE Annual Progress Report (APR) Form and Instruction
ATSDR Site Impact Assessment Form Form and Instruction
ATSDR Technical Assistance (TA) Activity Form Form and Instruction
ATSDR Health Education Activity Tracking (HEAT) Form Form and Instruction
Att6 APPLETREE 2023 Rev Research Determination.pdf Supplementary Document
Att5 APPLETREE 2023 PIA (PENDING APPROVAL WILL BE REPLACED).pdf Supplementary Document
Att3 APPLTREE NOFO No. CDC-RFA-TS-23-0001.pdf Supplementary Document
Att2 APPLETREE PMs 2023 Rev 60-day FRN.pdf Supplementary Document
Att1 APPLETREE PM 2023 Rev Authorizing Legislation CERCLA.pdf Supplementary Document
1 - SSB APPLETREE PMs 2023 Rev 20230831.docx Supporting Statement B
1 - SSA APPLETREE PMs 2023 Rev 20230831_final.docx Supporting Statement A
ATSDR Requests Form Form and Instruction
ATSDR Recommendation Follow-up Form and Instruction
ATSDR SoilSHOPS Form Form and Instruction
CSPECE Quantitative Form Form and Instruction
CSPECE Qualitative Narrative Form Form and Instruction
ATSDR Success Story Form Form and Instruction
APPLETREE Annual Progress Report (APR) Form and Instruction
ATSDR Site Impact Assessment Form Form and Instruction
ATSDR Technical Assistance (TA) Activity Form Form and Instruction
ATSDR Health Education Activity Tracking (HEAT) Form Form and Instruction

All Historical Document Collections

202309-0923-001 Approved without change	Revision of a currently approved collection	2023-09-19
202009-0923-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-09-28
202004-0923-001 Approved without change	Revision of a currently approved collection	2020-04-17
201704-0923-001 Approved without change	New collection (Request for a new OMB Control Number)	2017-04-27

OMB Details

ATSDR Health Education Activity Tracking (HEAT) Form

Federal Enterprise Architecture: Health - Consumer Health and Safety

Form n/a

Health Education (screenshots)

Fillable Fileable

Form and instruction

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