Healthy People 2030 Champion Application

Prevention Communication Formative Research

Documents and Forms

Document Name Document Type
Form Healthy People 203 Healthy People 2030 Champion Application Form and Instruction
Healthy People 203 Healthy People 2030 Champion Application Healthy People 2030 Champion Draft Application March 2022.docx Form and Instruction
HP2030 Champions Application 0990-0281 Supporting Statement A_Template 3.31.docx HP2030 Application Supplement IC Document

Information Collection (IC) Details

IC Title:	Healthy People 2030 Champion Application	Agency IC Tracking Number:

IC Status: Unchanged

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	Healthy People 2030 Champion Application	Healthy People 2030 Champion Application	Healthy People 2030 Champion Draft Application March 2022.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HP2030 Application Supplement	HP2030 Champions Application 0990-0281 Supporting Statement A_Template 3.31.docx	04/04/2022

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