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State/Local/Tribal Sector-Initial population
Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs
OMB: 0920-1053
IC ID: 214565
OMB.report
HHS/CDC
OMB 0920-1053
ICR 201612-0920-001
IC 214565
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1053 can be found here:
2018-02-27 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
State/Local/Tribal Sector-Initial population
Form
DCH screenshots
Att3a_DCH-PMD Screen Shots_3 14 16.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State/Local/Tribal Sector-Initial population
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Form
none
DCH screenshots
Att3a_DCH-PMD Screen Shots_3 14 16.docx
Yes
Yes
Fillable Fileable
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:
14
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
14
0
0
0
0
14
Annual IC Time Burden (Hours)
210
0
0
0
0
210
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.