PHHS Block Grant Management Information System (BG-MIS) Annual Report

Preventive Health and Health Services Block Grant

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0106 can be found here:

Documents and Forms

Document Name Document Type
Attach 5A Annual Report Instrument.doc Other-WORD
Attach 5B Annual Report Guidance.doc Guidance Document - Annual Report IC Document

Information Collection (IC) Details

IC Title:	PHHS Block Grant Management Information System (BG-MIS) Annual Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attach 5A Annual Report Instrument.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	61	61
Annual IC Time Burden (Hours)	1,830	1,830
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Guidance Document - Annual Report	Attach 5B Annual Report Guidance.doc	04/28/2008

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