BHW Performance Measures Forms

BHW Performance Report for Grants and Cooperative Agreements

Documents and Forms

Document Name Document Type
Form 1 BHW Performance Measures Forms Form and Instruction
0915-0061 - Appendix C - Program Mapping Document (updated).pdf Other-Program Mapping Document
1 Performance Metrics 2023.pdf BHW_0906_0086_Master Wireframe - Performance Metrics 05092025.docx Form and Instruction

Information Collection (IC) Details

IC Title:	BHW Performance Measures Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Performance Metrics 2023.pdf	BHW_0906_0086_Master Wireframe - Performance Metrics 05092025.docx		Yes	Yes	Fillable Fileable
Other-Program Mapping Document			0915-0061 - Appendix C - Program Mapping Document (updated).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,882	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,882	1,882
Annual IC Time Burden (Hours)	5,929	5,929
Annual IC Cost Burden (Dollars)	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.