Information Collection

Enhanced level awardees - Annual progress report

IC 210883 under ICR 201708-0920-005 · OMB 0920-0739.

Documents and Forms

Document Name Document Type
Enhanced level awardees - Annual progress report Form
Chronic disease management system Att 5. MIS Screen Shots.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Enhanced level awardees - Annual progress report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Chronic disease management system	Att 5. MIS Screen Shots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	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 Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	162	162
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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