OMB control number

DELTA Impact Recipient Monitoring and Assessment Tools

OMB 0920-1247 · HHS/CDC.

OMB 0920-1247

Collect information from recipients related to implementation and performance monitoring of cooperative agreement CDC-RFA-CE18-1801: Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Impact. Information to be collected will provide crucial data for performance monitoring, implementation of prevention strategies, and budget tracking.

The latest form for DELTA Impact Recipient Monitoring and Assessment Tools expires 2021-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1247 Annual Progress Report Tool Form and Instruction
Crosswalk of APR Changes May 14 new format.docx Supplementary Document
OMB_Change_Request_DELTA_051520 updated 6_8.docx Justification for No Material/Nonsubstantive Change
Att. 7. IRB - Research Determination DELTA Impact.pdf Supplementary Document
Att. 6. Privacy Act applicability.pdf Supplementary Document
Att. 5.FRN 60 Dy 0920-18FO DELTA IMPACT.pdf Supplementary Document
Att. 4 Crosswalk of Evaluation Questions.docx Supplementary Document
Att. 3a. Screenshots APR Tool.docx Supplementary Document
Att. 2. List of Grantees.docx Supplementary Document
Att. 1 Authorizing Legislation FVPSA-DELTA Impact.pdf Supplementary Document
SSB 19FO _ DELTA Impact 8.14.18.docx Supporting Statement B
SSA 19FO _ DELTA Impact 9.15.18_ICRO.docx Supporting Statement A
Annual Progress Report Tool Form and Instruction

All Historical Document Collections

202006-0920-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-06-19
201809-0920-001 Approved without change	New collection (Request for a new OMB Control Number)	2018-10-11