View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	PH LAW	Agency IC Tracking Number:	14AZP

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
Other-WORD			D_Instrument Word Version.docx		No		Printable Only
Other-Screen Shots			E_Instrument Web Version.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,522	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	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	1,522	0	1,522	0	0	0
Annual IC Time Burden (Hours)	152	0	152	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	XEU3-PHELC-EVAL-SSA.docx	09/24/2014
Supporting Statement B	XEU3-PHELC-EVAL-SSB.docx	09/25/2014
Att A PHEP Capabilities	A_PHEP Capabilities.pdf	09/24/2014
Att B 2008 National Action Agenda	B_2008 National Action Agenda.pdf	09/24/2014
Att C PHEL Competencies v.1.0	C_PHEL Competencies v. 1.0.pdf	09/24/2014
Att F Invitation Email	F_Invitation Email.docx	09/24/2014
Att G Reminder Email	G_Reminder Email.docx	09/24/2014

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