Information Collection Request

Evaluation of Public Health AmeriCorps

ICR 202406-3045-001 · OMB 3045-0199 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0199 can be found here:

Forms and Documents

Document Name	Status
Form 06 Training and TA Form Form and Instruction	Unchanged
Form 06 Training and TA Form Form and Instruction	Unchanged
Form 02 Grantee Survey Form and Instruction	Unchanged
Form 02 Grantee Survey Form and Instruction	Unchanged
Form 01 Early Exit Survey Form and Instruction	Unchanged
Form 01 Early Exit Survey Form and Instruction	Unchanged
Form 01 Member Alumni Survey Form and Instruction	Modified
Form 01 Member Alumni Survey Form and Instruction	Modified
PHA EVAL Justification of Nonsubstantive Change.docx Justification for No Material/Nonsubstantive Change	2024-06-05
PHA EVAL Justification of Nonsubstantive Change.docx Justification for No Material/Nonsubstantive Change	2024-06-05
30-Day Notice_02-06-24.pdf Supplementary Document	2024-02-06
30-Day Notice_02-06-24.pdf Supplementary Document	2024-02-06
60-Day PHA Evaluation.pdf Supplementary Document	2024-01-29
60-Day PHA Evaluation.pdf Supplementary Document	2024-01-29
42 U.S.C. 12639.pdf Supplementary Document	2024-01-29
42 U.S.C. 12639.pdf Supplementary Document	2024-01-29
EO 13996.pdf Supplementary Document	2024-01-29
EO 13996.pdf Supplementary Document	2024-01-29
3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docx Supporting Statement B	2024-04-04
3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docx Supporting Statement B	2024-04-04
3045-NEW PHA Member outcome Surveys_SSA_FINAL.docx Supporting Statement A	2024-04-04
3045-NEW PHA Member outcome Surveys_SSA_FINAL.docx Supporting Statement A	2024-04-04

IC Document Collections

IC ID	Document Title	Status
264766	Partner Interview Other-Interview Questions	Unchanged
264765	Early Exit Interview Other-Interview Questions	Unchanged
264764	Grantee Focus Group Other-Focus Group Questions	Unchanged
264741	Training and TA Form Form and Instruction	Unchanged
264741	Training and TA Form Form and Instruction	Unchanged
264740	Grantee Survey Form and Instruction	Unchanged
264740	Grantee Survey Form and Instruction	Unchanged
264739	Early Exit Survey Form and Instruction	Unchanged
264739	Early Exit Survey Form and Instruction	Unchanged
264738	Member Alumni Survey Form and Instruction	Modified
264738	Member Alumni Survey Form and Instruction	Modified

ICR Details

Status	Active
Agency/Subagency	CNCS
OMB Control No	3045-0199
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202311-3045-001
Date Submitted to OIRA	2024-06-05
Requested Expiration Date	1969-12-31