Annual Performance Report

[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION

Documents and Forms

Document Name Document Type
Form 0920-23AA Annual Performance Report Form and Instruction
0920-23AA Att. 3a APR Tool Att. 3a APR Tool.pdf Form and Instruction
0920-23AA Att. 3a APR Tool Att. 3a APR Tool.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Performance Report	Agency IC Tracking Number:	0920-23AA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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	0920-23AA	Att. 3a APR Tool	Att. 3a APR Tool.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	130	130
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.