Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Birth Defects Prevelance Form Modified 22 1760 0 Form and Instruction 0920-1175 Birth Defects Prevalence
Childhood Lead Blood Levels Form Modified 18 1440 0 Form and Instruction 0920-1175 Childhood Lead Blood Levels Form
Communications Plan Modified 30 600 0 Form and Instruction none Communications Plan Form
Community Drinking Water Monitoring Form Modified 30 3000 0 Form and Instruction 0920-1175 Community Drinking Water Monitoring Form
Emergency Department Visits Form Modified 30 2400 0 Form and Instruction 0920-1175 Emergency Department Visits
Environmental Public Health Tracking Work Plan Template Modified 30 1200 0 Form and Instruction none Environmental Public Health Tracking Work Plan Template
Hospitalizations Modified 30 2400 0 Form and Instruction 0920-1175 Hospitalizations
Metadata Records Modified 180 3600 0 Form and Instruction 0920-1175 Metadata Records
Performance Measurement Strategy Report New 30 600 0 Form and Instruction none Performance Measurement Strategy Report
Publilc Health Action Report - Existing Awardees Modified 120 2400 0 Form and Instruction none Public Health Action Report (Existing Awardees) Form
Radon Testing Modified 18 1800 0 Form and Instruction 0920-1175 Radon Testing Form
Tracking Program Grantee Partnership Plan Template Instructions Modified 30 600 0 Form and Instruction none Tracking Program Grantee Partnership Plan
Website Analytics Modified 60 60 0 Form and Instruction none Website Analytics Form
Total burden requested under this ICR: 628 21860 0  
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