Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Dictionary - Emergency Department (ED) Visits Modified 37 1480 0 Form and Instruction 0920-1175 Data Dictionary - Emergency Department (ED) Visits
Data Dictionary for Data Submission -- Labs Radon Data Modified 25 1250 0 Form and Instruction 0920-1175 Radon Testing Form
Data Dictionary – Birth Defects (Prevelance) Form Modified 30 1200 0 Form and Instruction 0920-1175 Data Dictionary -- Birth Defects(Prevalence)
Data Dictionary – Drinking Water (Community Monitoring) Modified 37 1850 0 Form and Instruction 0920-1175 Data Dictionary – Drinking Water (Community Monitoring)
Data Dictionary- Hospitalizations Modified 37 1480 0 Form and Instruction 0920-1175 Data Dictionary- Hospitalizations
Data Dictionary- State Biomonitoring Data Modified 25 1000 0 Form and Instruction 0920-1175 Data Dictionary- State Biomonitoring Data
Environment Public Health Tracking -- Childhood Blood Lead Poisoning Modified 37 1480 0 Form and Instruction 0920-1175 Environmental Public Health Tracking - CHILDHOOD BLOOD LEAD POISONING
Environmental Public Health Tracking Work Plan Template Modified 37 777 0 Form and Instruction 0920-1175 Modernizing Environmental Public Health Tracking to Advance Enviromental Health Surveillance Work Plan Template
Metadata Sample Content Modified 74 1480 0 Form and Instruction 0920-1175 Metadata Sample Content
Outreach & Communication Plan Template with Instructions Modified 37 74 0 Form and Instruction 0920-1175 Outreach & Communication Plan Template with Instructions
PHA Impact Follow Up - (RedCap form) (New form) New 74 19 0 Form and Instruction 0920-1175 PA/PHA Impact Followup
Performance Measures- Unique Modified 37 740 0 Form and Instruction 0920-1175 Performance Measurses - Unique
Publilc Health Action Report - Existing Awardees Modified 74 1480 0 Form and Instruction 0920-1175 Program Accomplishments & Public Health Actions
Standardized Web Statistics - Codebook Modified 74 74 0 Form and Instruction 0920-1175 Standardized Web Statistics - Codebook
Total burden requested under this ICR: 635 14384 0  
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