Annual Progress Report Instrument

[PHIC] Preventive Health and Health Services Block Grant

Documents and Forms

Document Name Document Type
Annual Progress Report Instrument Form and Instruction
Annual Progress Report Instruments Att F_Annual Progress Report Instruments_081420.docx Form and Instruction
Annual Progress Report Instruments Att F_Annual Progress Report Instruments_081420.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Progress Report Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	none	Annual Progress Report Instruments	Att F_Annual Progress Report Instruments_081420.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-61	61
Annual IC Time Burden (Hours)	-671	671
Annual IC Cost Burden (Dollars)	-231,227	231,227

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.