OMB
.report
Search
Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance
Communities Putting Prevention to Work
OMB: 0920-0820
IC ID: 190673
OMB.report
HHS/CDC
OMB 0920-0820
ICR 200909-0920-009
IC 190673
( )
Documents and Forms
Document Name
Document Type
Form 3
Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance
Form and Instruction
3 Supplemental Funds Application
0920-XXXX Supplemental Funding Application Attch 3.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
3
Supplemental Funds Application
0920-XXXX Supplemental Funding Application Attch 3.doc
Yes
Yes
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
53
0
-8
0
0
61
Annual IC Time Burden (Hours)
2,120
0
-320
0
0
2,440
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.