Information Collection

National Public Health Performance Standards Program Local Public Health Governance Performance Assessment Tool

IC 7041 under ICR 200706-0920-007 · OMB 0920-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0580 can be found here:

Documents and Forms

Document Name Document Type
Form 1 National Public Health Performance Standards Program Local Public Health Governance Performance Assessment Tool Form and Instruction
1 Attachment E Instruments Governance(r) Attachment E Instruments Governance(r).pdf www.NPHPSP-results.org Form and Instruction
Attachment F Facilitators Guide.doc Attachment F Facilitators Guide IC Document
Attachment G How to Enter NPHPSP Responses.pdf Attachment G How to Enter NPHPSP Responses IC Document
Attachment H screenshot examples.pdf Attachment H screenshot examples IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Public Health Performance Standards Program Local Public Health Governance Performance Assessment Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Attachment E Instruments Governance(r)	Attachment E Instruments Governance(r).pdf	www.NPHPSP-results.org	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175	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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	175	-892	1,067
Annual IC Time Burden (Hours)	875	-5,527	6,402
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F Facilitators Guide	Attachment F Facilitators Guide.doc	05/09/2007
Attachment G How to Enter NPHPSP Responses	Attachment G How to Enter NPHPSP Responses.pdf	05/09/2007
Attachment H screenshot examples	Attachment H screenshot examples.pdf	05/09/2007

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