OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Delta Impact Cooperative Agreement Evaluation data collection Instruments

ICR 202007-0920-007 · OMB 0920-1324 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920- Att 6_ Instrument: PREVENTION INFRASTRUCTURE ASSESSMENT Form and Instruction New Repair queued
Form 0920- Att 5: Instrument: Subrecipient Survey Form and Instruction New Repair queued
Form 0920- Att 4_Instrument: Key Informant Interview – Lead Evaluator Form and Instruction New Missing upstream
Form 0920- Att 3_Key Informant Interview--Project Lead Form and Instruction New Missing upstream
DELTA Impact Att 9_Privacy Act Email.pdf Supplementary Document Uploaded 2020-08-05 Repair queued
DELTA Impact Att. 8 Crosswalk of DELTA Impact Evaluation Questions and Data Collection.docx Supplementary Document Uploaded 2020-08-05 Repair queued
Att 7_ Project Determination.pdf Supplementary Document Uploaded 2020-08-05 Missing upstream
Att2 _60 Day FRN.pdf Supplementary Document Uploaded 2020-08-05 Repair queued
DELTA Impact Att 1 Authorizing Legislation FVPSA.pdf Supplementary Document Uploaded 2020-08-05 Missing upstream
SSB_DELTA Impact 2.12.20.docx Supporting Statement B Uploaded 2020-08-05 Missing upstream
SSA_DELTA Impact 063020.docx Supporting Statement A Uploaded 2020-08-05 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
243035 Att 6_ Instrument: PREVENTION INFRASTRUCTURE ASSESSMENT Form and Instruction New
243034 Att 5: Instrument: Subrecipient Survey Form and Instruction New
243033 Att 4_Instrument: Key Informant Interview – Lead Evaluator Form and Instruction New
243032 Att 3_Key Informant Interview--Project Lead Form and Instruction New
ICR Details
202007-0920-007
Received in OIRA
HHS/CDC 0920-20JC
Delta Impact Cooperative Agreement Evaluation data collection Instruments
New collection (Request for a new OMB Control Number)   No
Regular 08/06/2020
  Requested Previously Approved
36 Months From Approved
57 0
47 0
0 0
The goal of this ICR is to collect information from recipients related to program evaluation activities for cooperative agreement CDC-RFA-CE18-1801: Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Impact.
None
None
Not associated with rulemaking
  85 FR 11990 02/28/2020
85 FR 43850 07/20/2020
No
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 57 0 0 30 27 0
Annual Time Burden (Hours) 47 0 0 18 29 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a NEW information collection request.
$10,573
No
    No
    No
No
No
No
No
Thelma Sims 4046394771
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/06/2020