Information Collection Request
Evaluation of Public Health AmeriCorps
ICR 202406-3045-001 · OMB 3045-0199 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3045-0199 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 06 Training and TA Form |
Form and Instruction | Unchanged | Available |
| Form 06 Training and TA Form |
Form and Instruction | Unchanged | Repair queued |
| Form 02 Grantee Survey |
Form and Instruction | Unchanged | Repair queued |
| Form 02 Grantee Survey |
Form and Instruction | Unchanged | Repair queued |
| Form 01 Early Exit Survey |
Form and Instruction | Unchanged | Repair queued |
| Form 01 Early Exit Survey |
Form and Instruction | Unchanged | Repair queued |
| Form 01 Member Alumni Survey |
Form and Instruction | Modified | Repair queued |
| Form 01 Member Alumni Survey |
Form and Instruction | Modified | Repair queued |
 PHA EVAL Justification of Nonsubstantive Change.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-06-05 | Repair queued |
| PHA EVAL Justification of Nonsubstantive Change.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-06-05 | Repair queued |
 30-Day Notice_02-06-24.pdf |
Supplementary Document | Uploaded 2024-02-06 | Repair queued |
| 30-Day Notice_02-06-24.pdf |
Supplementary Document | Uploaded 2024-02-06 | Missing upstream |
| 60-Day PHA Evaluation.pdf |
Supplementary Document | Uploaded 2024-01-29 | Repair queued |
| 60-Day PHA Evaluation.pdf |
Supplementary Document | Uploaded 2024-01-29 | Repair queued |
| 42 U.S.C. 12639.pdf |
Supplementary Document | Uploaded 2024-01-29 | Repair queued |
| 42 U.S.C. 12639.pdf |
Supplementary Document | Uploaded 2024-01-29 | Repair queued |
| EO 13996.pdf |
Supplementary Document | Uploaded 2024-01-29 | Available |
| EO 13996.pdf |
Supplementary Document | Uploaded 2024-01-29 | Repair queued |
| 3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docx |
Supporting Statement B | Uploaded 2024-04-04 | Repair queued |
| 3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docx |
Supporting Statement B | Uploaded 2024-04-04 | Repair queued |
| 3045-NEW PHA Member outcome Surveys_SSA_FINAL.docx |
Supporting Statement A | Uploaded 2024-04-04 | Available |
| 3045-NEW PHA Member outcome Surveys_SSA_FINAL.docx |
Supporting Statement A | Uploaded 2024-04-04 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 264766 |  Partner Interview |
Other-Interview Questions | Unchanged | |
| 264765 | Early Exit Interview |
Other-Interview Questions | Unchanged | |
| 264764 | Grantee Focus Group |
Other-Focus Group Questions | Unchanged | |
| 264741 | Training and TA Form |
Form and Instruction | Unchanged | |
| 264741 | Training and TA Form |
Form and Instruction | Unchanged | |
| 264740 | Grantee Survey |
Form and Instruction | Unchanged | |
| 264740 | Grantee Survey |
Form and Instruction | Unchanged | |
| 264739 | Early Exit Survey |
Form and Instruction | Unchanged | |
| 264739 | Early Exit Survey |
Form and Instruction | Unchanged | |
| 264738 | Member Alumni Survey |
Form and Instruction | Modified | |
| 264738 | Member Alumni Survey |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | CNCS |
| OMB Control No | 3045-0199 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202311-3045-001 |
| Date Submitted to OIRA | 2024-06-05 |
| Requested Expiration Date | 1969-12-31 |