View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	State and Local Environmental Public Health Employees Usage of Public Health Assessments and Consultations Documents	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ATSDR Attachment F Clearance Process Evaluation Executive Summary.docx		Yes	Yes	Fillable Printable
Instruction			ATSDR Attachment G Community Report Redesign_A.pdf		Yes	Yes	Printable Only
Instruction			ATSDR Attachment J Phone Screener.doc		Yes	Yes	Printable Only
Instruction			ATSDR Attachment H Health Consultation Brochure Redesign_B.ppt		Yes	Yes	Printable Only
Instruction			ATSDR Attachment I HC Redesign Template_C.pdf		Yes	Yes	Printable Only
Instruction			ATSDR Attachment K Focus Group Data Collection Tool.doc		Yes	Yes	Printable Only
Instruction			ATSDR Attachment L FOCUS GROUP CONFIRMATION EMAIL.docx		Yes	Yes	Printable Only
Instruction			ATSDR Attachment M Focus Group Reminder Script.docx		Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	150	0	0	0	0	0
Annual IC Time Burden (Hours)	125	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ATSDR Supporting_Statement_B	ATSDR Supporting_Statement_B.docx	01/15/2013
ATSDR Attachment A CERCLA Authorizing Legislation	ATSDR Attachment A CERCLA Authorizing Legislation.pdf	01/15/2013
ATSDR Attachment B RCRA Legislation	ATSDR Attachment B RCRA Legislation.pdf	01/15/2013
ATSDR Attachment C National Priorities List	ATSDR Attachment C National Priorities List.docx	01/15/2013
ATSDR Attachment D Oak Ridge Y-12_PHA	ATSDR Attachment D Oak Ridge Y-12_PHA.pdf	01/15/2013
ATSDR Attachment E MidlothianAreaAirQuality_HC	ATSDR Attachment E MidlothianAreaAirQuality_HC.pdf	01/15/2013
ATSDR Supporting_Statement_A	ATSDR Supporting_Statement_A.docx	01/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.