Information Collection

Performance Measure Data Report Form (Instrument 4)

IC 223555 under ICR 202012-0970-016 · OMB 0970-0497.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0497 can be found here:

Documents and Forms

Document Name Document Type
Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx Other-Data Entry Form
Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx Other-Data Entry Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Performance Measure Data Report Form (Instrument 4)	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
Other-Data Entry Form			Instrument 4_PREP Subawardee Data Collection & Reporting Form_clean_121420.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 391	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	782	-50	832
Annual IC Time Burden (Hours)	10,989	-1,023	12,012
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.