Evaluation of Public Health AmeriCorps

ICR 202311-3045-001

OMB: 3045-0199

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0199 can be found here:

2025-03-26 - No material or nonsubstantive change to a currently approved collection
2024-06-05 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form 06 Training and TA Form Form and Instruction	New
Form 02 Grantee Survey Form and Instruction	New
Form 01 Early Exit Survey Form and Instruction	New
Form 01 Member Alumni Survey Form and Instruction	New
30-Day Notice_02-06-24.pdf Supplementary Document	2024-02-06
60-Day PHA Evaluation.pdf Supplementary Document	2024-01-29
42 U.S.C. 12639.pdf Supplementary Document	2024-01-29
EO 13996.pdf Supplementary Document	2024-01-29
3045-NEW PHA Member Outcome Surveys_SSB.docx Supporting Statement B	2024-01-29
3045-NEW PHA Member outcome Surveys_SSA.docx Supporting Statement A	2024-01-29

IC Document Collections

IC ID	Document Title	Status
264766	Partner Interview Other-Interview Questions	New
264765	Early Exit Interview Other-Interview Questions	New
264764	Grantee Focus Group Other-Focus Group Questions	New
264741	Training and TA Form Form and Instruction	New
264740	Grantee Survey Form and Instruction	New
264739	Early Exit Survey Form and Instruction	New
264738	Member Alumni Survey Form and Instruction	New

ICR Details

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