Information Collection List

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