OMB control number

[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION

OMB 0920-1412 · HHS/CDC.

OMB 0920-1412

The purpose of this data collection is to collect monitoring data project performance and implementation of cooperative agreement for Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Achieving Health Equity through Addressing Disparities (AHEAD). Information collected from recipients on state- and local-level will provide crucial data for performance monitoring of the cooperative agreement and will provide CDC with the capacity to respond in a timely manner to requests for information about the program from the Department of Health and Human Services (HHS), the White House, Congress, and other sources. Recipients will report progress and activity information to CDC on an annual schedule using a web-based Partners’ Portal and web-based survey tool. This Non-Substantive Change Request is submitted to make updates to questions used in OMB 0920-1412 - DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUTATION to be in accordance with EO 14168 & EO 14151. There is a net decrease of 5 burden hours.

The latest form for [NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION expires 2026-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-23AA Health Equity Capacity Assessment Form and Instruction
Form 0920-23AA Prevention Infrastructure Assessment Form and Instruction
Form 0920-23AA Key Informant Interview Evaluator Form and Instruction
Form 0920-23AA Key Informant Interview – Project Lead Form and Instruction
Form 0920-23AA Annual Performance Report Form and Instruction
Change Request Memo - 0920-1412.docx Justification for No Material/Nonsubstantive Change
Att. 5b Prevention Infrastructure Assessment Screenshots Updated.pdf Supplementary Document
Att. 3b DELTA AHEAD APR Screenshots.docx.pdf Supplementary Document
Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf Supplementary Document
SSA - DELTA AHEAD clean 0920-1412.docx Supporting Statement A
SSB - DELTA AHEAD clean 1412.docx Supporting Statement B
Health Equity Capacity Assessment Form and Instruction
Prevention Infrastructure Assessment Form and Instruction
Key Informant Interview Evaluator Form and Instruction
Key Informant Interview – Project Lead Form and Instruction
Annual Performance Report Form and Instruction

All Historical Document Collections

202507-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2025-07-11
202305-0920-013 Approved without change	New collection (Request for a new OMB Control Number)	2023-06-13

OMB Details

Annual Performance Report

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-23AA	Att. 3a APR Tool	Fillable Fileable	Form and instruction
Form 0920-1412	APR Tool - 11JUL2025	N/A	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.