View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

State & Local HH & LPP Programs: Baseline Profile Assessment 16PM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0879 Att C InstrumentMSWord Att C InstrumentMSWord.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0879 Att D Instrument Web Version Att D Instrument Web Version.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

35 0
   
State, Local, and Tribal Governments
 
   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 35 0 35 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att E Notification Email Att E Notification Email.docx 02/18/2016
Att F Reminder Email Att F Reminder Email.docx 02/18/2016
Att A Awarded Jurisdictions Att A Awarded Jurisdictions.docx 02/18/2016
Att B Letter for Bona Fide Agent Att B Letter for Bona Fide Agent.pdf 02/18/2016
Final PROF-LEAD-SSA Final PROF-LEAD-SSA.docx 02/18/2016
Final PROF-LEAD-SSB Final PROF-LEAD-SSB.docx 02/18/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.