View Information Collection (IC)

View Information Collection (IC)

IC Title:	Performance Measurement for STD Prevention (NCHHSTP, 2020-2022)	Agency IC Tracking Number:	0920-20KO

IC Status: New

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	n/a	STD PCHD Performance Measurement Tool	Att 1_Data Collection Tool_02242020.xlsx		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: 59	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	177	0	177	0	0	0
Annual IC Time Burden (Hours)	5,310	0	5,310	0	0	0
Annual IC Cost Burden (Dollars)	193,231	0	193,231	0	0	0

Documents for IC

Title	Document	Date Uploaded
Template with Project Description	PPEO GenIC Template- PS19-1901 STD PCHD_02242020.docx	02/24/2020
Notification Email	Att 2_Notification Email.v2.docx	02/24/2020
STD PCHD Overview and Logic Model	Att 3 STD PCHD Overview and Logic Model.pdf	02/24/2020

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