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Performance Measures to Address COVID-19-Related Health Disparities in Support of the Implementation of the OT21-2103 COVID-19 Health Disparities Grant 0920-1282-22BW
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Reporting Template Appendix B_1 Modified Reporting Template CDC OT21-2103_Performance Measures Report_Offline_Collaboration_Aid_REDCap.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

108 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 432 0 432 0 0 0
Annual IC Time Burden (Hours) 12,960 0 12,960 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Performance Measures Guidance Appendix A Modified Technical Specifications CDC OT21-2103 Performance Measure Guidance v1.pdf 01/13/2022
Screenshots Reporting Template Appendix B_2_Screenshots REDCap Data Entry Fields OT21-2103 .pdf 01/13/2022
OMB Control Header and Burden Statement OMB Control Header and Burden Statement.docx 01/13/2022
Research Determination project-summary-0900f3eb81cc6920-1-7-2022-10_31_28.pdf 01/13/2022
GenIC Request Template PPEO GenIC Request-CDC programs- CSTLTS_OT21-2103_Clearance_122021.docx 01/13/2022
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