Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Health Center Performance Measure Reporting Tool New 21 126 0 Form and Instruction NA
Annual Health Center Performance Measure Reporting Tool New 4 24 0 Form and Instruction NA
Awardee Performance Measure Reporting Tool New 3 3 0 Form and Instruction NA
Awardee Training and Techmnical Assistance Tool New 36 72 0 Form and Instruction NA
Health Center Organizational Assessment New 4 8 0 Form and Instruction NA
Health Center Organizational Assessment New 21 42 0 Form and Instruction NA
Health Center Provider Survey New 126 42 0 Form and Instruction NA
Health Center Provider Survey New 24 8 0 Form and Instruction NA
Health Center Youth Survey New 1050 175 0 Form and Instruction NA
Quarterly Health Center Perfoemance Measure Reporting Tool New 12 48 0 Form and Instruction NA
Quarterly Health Center Performance Measure Reporting Tool New 63 252 0 Form and Instruction NA
Youth Serving Organization (YSO) Organizational Assessment New 20 20 0 Form and Instruction NA
Youth Serving Organization (YSO) Organizational Assessment New 15 15 0 Form and Instruction NA
Youth Serving Organization (YSO) Performance Measure Reporting Tool New 80 80 0 Form and Instruction NA
Youth Serving Organization (YSO) Performance Measure Reporting Tool New 60 60 0 Form and Instruction NA
Youth Serving Organization (YSO) Staff Survey New 300 100 0 Form and Instruction NA
Youth Serving Organization (YSO) Staff Survey New 225 75 0 Form and Instruction NA
Total burden requested under this ICR: 2064 1150 0  
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