Information Collection

Awardee Lead Profile Assessment (ALPA) Web Survey

IC 228696 under ICR 202010-0920-015 · OMB 0920-1215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1215 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1215 Awardee Lead Profile Assessment (ALPA) Web Survey Form and Instruction
0920-1215 Awardee Lead Profile Assessment (ALPH) Web Survey Att4a ALPA Web Survey 20200928.docx Form and Instruction
0920-1215 Awardee Lead Profile Assessment (ALPH) Web Survey Att4a ALPA Web Survey 20200928.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Awardee Lead Profile Assessment (ALPA) Web Survey	Agency IC Tracking Number:	0920-1215

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1215	Awardee Lead Profile Assessment (ALPH) Web Survey	Att4a ALPA Web Survey 20200928.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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	Previously Approved
Annual Number of Responses for this IC	60	12	48
Annual IC Time Burden (Hours)	47	41	6
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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