[PHIC] Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant

ICR 202506-0920-016

OMB: 0920-1257

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1257 Preventive Health and Health Services Block Grant Assessment Form	Modified
Att 1_PHHS BG Recipients.docx Supplementary Document	2025-06-25
Att 2_Authorizing Legislation.pdf Supplementary Document	2025-06-25
Att 3_Measure Framework v1.5.docx Supplementary Document	2025-06-25
Att 7_Privacy Impact Assessment.pdf Supplementary Document	2025-06-25
Att 8_Research Determination.pdf Supplementary Document	2025-06-25
Att 9_Invitation Email.docx Supplementary Document	2025-06-25
Att 10_Reminder Email.docx Supplementary Document	2025-06-25
Att 11_Final Reminder Email.docx Supplementary Document	2025-06-25
Attachment 2- Authorizing Legis 42_USC_PHHSBG_Current_2021.pdf Supplementary Document	2022-04-25
Attachment 3- PHHS Block Grant Measurement Framework_Vers1.5 updated cz.docx Supplementary Document	2022-04-25
Attachment 7 - Privacy Impact Assessment.pdf Supplementary Document	2022-04-25
Attachment 8- Non-Research Determination.pdf Supplementary Document	2022-04-25
Attachment 1- List of PHHS Block Grant Grantees.docx Supplementary Document	2022-04-25
30 day FRN_PHHS Block Grant Assessment Extension_2022 01 24.docx Supplementary Document	2022-04-25
1257_SSB_3.27.25.docx Supporting Statement B	2025-06-25
1257_SSA_3.27.25.docx Supporting Statement A	2025-06-25

IC Document Collections

IC ID	Document Title	Status
234732	Preventive Health and Health Services Block Grant Assessment Form	Modified