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 for Data Submission -- Labs Radon Data Unchanged 25 1250 0 Form and Instruction 0920-1175
Data Dictionary – Birth Defects (Prevelance) Form Modified 30 1200 0 Form and Instruction 0920-1175
Data Dictionary – Drinking Water (Community Monitoring) Unchanged 37 1850 0 Form and Instruction 0920-1175
Data Dictionary- Hospitalizations Modified 37 1480 0 Form and Instruction 0920-1175
Data Dictionary- State Biomonitoring Data Modified 25 1000 0 Form and Instruction 0920-1175
Environment Public Health Tracking -- Childhood Blood Lead Poisoning Unchanged 37 1480 0 Form and Instruction 0920-1175
Environmental Public Health Tracking Work Plan Template Unchanged 37 777 0 Form and Instruction 0920-1175
Metadata Sample Content Unchanged 74 1480 0 Form and Instruction 0920-1175
Outreach & Communication Plan Template with Instructions Unchanged 37 74 0 Form and Instruction 0920-1175
PHA Impact Follow Up - (RedCap form) (New form) Unchanged 74 19 0 Form and Instruction 0920-1175
Performance Measures- Unique Unchanged 37 740 0 Form and Instruction 0920-1175
Publilc Health Action Report - Existing Awardees Unchanged 74 1480 0 Form and Instruction 0920-1175
Standardized Web Statistics - Codebook Unchanged 74 74 0 Form and Instruction 0920-1175
Total burden requested under this ICR: 635 14384 0  
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