View Information Collection (IC)

View Information Collection (IC)

IC Title:	National Public Health Performance Standards Program State Public Health Performance Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Attachment E Instruments State	Attachment E Instruments State.pdf	www.NPHPSP-results.org	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	8	0	1	0	0	7
Annual IC Time Burden (Hours)	96	0	-9	0	0	105
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F FacilitatorGuide State v	Attachment F FacilitatorGuide State v.2.doc	05/07/2007
Attachment G How to Enter NPHPSP Responses	Attachment G How to Enter NPHPSP Responses.pdf	05/07/2007
Attachment H screenshot example State revised	Attachment H screenshot example State revised.pdf	05/07/2007

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