National Organizations

Prevention and Wellness-Leveraging National Organizations

Documents and Forms

Document Name Document Type
0990-Attachment_C-_National_Organizations_Output_Measures_Template(1).xls Other-instrument
0990-Attachment_B_-_National_Organizations_Outcome_Measure_Template(1).xls Other-instrument
0990-Attachment A - MAPPS_Intervention_Table.pdf 0990-Attachment A - MAPPS_Intervention_Table IC Document

Information Collection (IC) Details

IC Title:	National Organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-instrument			0990-Attachment_C-_National_Organizations_Output_Measures_Template(1).xls		No	No	Paper Only
Other-instrument			0990-Attachment_B_-_National_Organizations_Outcome_Measure_Template(1).xls		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0990-Attachment A - MAPPS_Intervention_Table	0990-Attachment A - MAPPS_Intervention_Table.pdf	12/07/2010

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