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2-Enhanced Component -Initial Population-Annual Progress Report
Monitoring and Reporting for the Core State Violence and Injury Prevention Program Cooperative Agreement
OMB: 0920-1120
IC ID: 220451
OMB.report
HHS/CDC
OMB 0920-1120
ICR 201603-0920-003
IC 220451
( )
Documents and Forms
Document Name
Document Type
Att C2_Enhanced 021116.pdf
Other-WORD
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
2-Enhanced Component -Initial Population-Annual Progress Report
Agency IC Tracking Number:
16BZ
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-WORD
Att C2_Enhanced 021116.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
5
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
5
0
5
0
0
0
Annual IC Time Burden (Hours)
730
0
730
0
0
0
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.