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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 [CSTLTS, revised August 2022] 0920-1282-22IG
 
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 None Reporting Template App B_1 Modified Reporting Template CDC OT21-2103_Performance Measures V2 Report.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) 15,120 0 15,120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC Request Template (Project Description and Justification) PPEO GenIC Request-CDC programs- CSTLTS_OT21-2103-PMv2_OMB.pdf 08/22/2022
Performance Measures Guidance App A_Modified Technical Specs CDC OT21-2103 Performance Measure Guidance v2.pdf 08/22/2022
Screenshots of the Reporting Template App B_2_CDC OT21-2103_Screenshots OT21-2103.pdf 08/22/2022
Sample Recipient Notification CSTLTS_OT21-2103-sample_draft_recipient_notification_ICRO.docx 08/22/2022
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