Annual Performance Report (APR) Tool

[NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program

Documents and Forms

Document Name Document Type
Form 0920- Annual Performance Report (APR) Tool Form and Instruction
0920- Annual Performance Report (APR) Tool Att. 3 Annual Performance Report (APR) Tool.docx Form and Instruction
0920- Annual Performance Report (APR) Tool Att. 3 Annual Performance Report (APR) Tool.docx Form and Instruction
Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf Annual Performance Report (APR) Tool (WORD) IC Document
Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf Annual Performance Report (APR) Tool (WORD) IC Document

Information Collection (IC) Details

IC Title:	Annual Performance Report (APR) Tool	Agency IC Tracking Number:	0920-23DT

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
Form and Instruction	0920-	Annual Performance Report (APR) Tool	Att. 3 Annual Performance Report (APR) Tool.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	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	12	12
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual Performance Report (APR) Tool (WORD)	Att. 3a Annual Performance REport (APR) Tool Screenshots.pdf	10/12/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.