View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	BE Review (Built Environment) Healthy Community Design: Assessment of Local Health and Planning Departments	Agency IC Tracking Number:	15SB

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
Form and Instruction	None	LHD Instrument - Web	B_LHD Instrument Web.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Planner Instrument	E_Planner Instrument Web.docx	None	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,130	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	1,130	0	1,130	0	0	0
Annual IC Time Burden (Hours)	283	0	283	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	1 HGQ8-BE-REVIEW-SSA.docx	03/06/2015
Supporting Statement B	2 HGQ8-BE-REVIEW-SSB.docx	03/06/2015
LHD Instrument - WORD	C_LHD Instrument Word.docx	03/06/2015
Planner Instrument - WORD	D_Planner Instrument Word.docx	03/06/2015
2004 Assessment Report	A_2004 Assessment Report.pdf	03/06/2015
APA Advance Email	F_APA Advance Email.docx	03/06/2015
NACCHO Advance Email	G_NACCHO Advance Email.docx	03/06/2015
Reminder Email Non-Response 10 Day APA	H_Reminder Email_Non-response 10 Day APA.docx	03/06/2015
Reminder Emial Non-Response 10 Day NACCHO	I_Reminder Email_Non-response 10 Days NACCHO.docx	03/06/2015
Reminder Email Non-Response 15 Day APA	J_Reminder Email_Non-response 15 Day APA.docx	03/06/2015
Reminder Email Non-Response 15 Day NACCHO	K_Reminder Email_Non-response 15 Days NACCHO.docx	03/06/2015
Reminder Email 10 Day Partial APA	L_ Reminder Email 10 Days Partial APA.docx	03/06/2015
Reminder Email 10 Day Partial NACCHO	M_ Reminder Email 10 Days Partial NACCHO.docx	03/06/2015
Reminder Email 15 Day Partial APA	N_ Reminder Email 15 Days Partial APA.docx	03/06/2015
Reminder Email 15 Day Partial NACCHO	O_ Reminder Email 15 Days Partial NACCHO.docx	03/06/2015

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