OD2A-LOCAL Evaluation & Performance Measurement Plan Template

[NCIPC] Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement

Documents and Forms

Document Name Document Type
Form 0920-n/a OD2A-LOCAL Evaluation & Performance Measurement Plan Template Form and Instruction
0920-n/a OD2A-LOCAL Evaluation and Performance Measuring Plan Tem Attachment 3h_OD2A-LOCAL Evaluation and Performance Measurement Plan Template.docx Form and Instruction
0920-n/a OD2A-LOCAL Evaluation and Performance Measuring Plan Tem Attachment 3h_OD2A-LOCAL Evaluation and Performance Measurement Plan Template.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OD2A-LOCAL Evaluation & Performance Measurement Plan Template	Agency IC Tracking Number:	0920-1283

Is this a Common Form? No		IC Status: New

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 and Instruction	0920-n/a	OD2A-LOCAL Evaluation and Performance Measuring Plan Template	Attachment 3h_OD2A-LOCAL Evaluation and Performance Measurement Plan Template.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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 Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	40	-26	66
Annual IC Time Burden (Hours)	14	-250	264
Annual IC Cost Burden (Dollars)	0	-8,802	8,802

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.