Grantee program staff-Tier 1 A/B

ACYF Pregnancy Prevention Performance Measure Collection

Documents and Forms

Document Name Document Type
0990-PM OMB ICR Instrument 3 Reporting Form AB Grantees 8-4.docx Other-survey
0990-0392 Appendix D Example of Evaluation Grantee Consent 5 1 2012 (2).doc Other-form

Information Collection (IC) Details

IC Title:	Grantee program staff-Tier 1 A/B	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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-survey			0990-PM OMB ICR Instrument 3 Reporting Form AB Grantees 8-4.docx		Yes	Yes	Fillable Printable
Other-form			0990-0392 Appendix D Example of Evaluation Grantee Consent 5 1 2012 (2).doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-59	59
Annual IC Time Burden (Hours)	-1,121	1,121
Annual IC Cost Burden (Dollars)	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.