Cli

Evaluation for the Partnerships for Success Program

Documents and Forms

Document Name Document Type
Form CLI CLI Form and Instruction
CLI CLI Attachment2 PFS_CLI_FINAL_OMB_10-1-2014.doc Form and Instruction

Information Collection (IC) Details

IC Title:	CLI	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	CLI	CLI	Attachment2 PFS_CLI_FINAL_OMB_10-1-2014.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 786	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	1,364	330	1,034
Annual IC Time Burden (Hours)	3,546	858	2,688
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.