View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Community Health Status Indicators (CHSI) 2015: Awareness, Use, and Benefits Assessment 16ADY
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 16ADY No   Fillable Printable
Form and Instruction 16ADY No   Fillable Printable
Form and Instruction 16ADY No   Fillable Printable

Health Public Health Monitoring

 

78 0
   
State, Local, and Tribal Governments
 
   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 78 0 78 0 0 0
Annual IC Time Burden (Hours) 37 0 37 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
A. Targeted Local Health Departments_CHSI 04/22/2016
E. Contact Reminder Call_CHSI 04/22/2016
F. Focus Group Scheduling Call_CHSI 04/22/2016
G. Focus Group Confirmation Email_CHSI 04/22/2016
H. Focus Group Confirmation Call_CHSI 04/22/2016
SSA CHSI-EVAL 04/22/2016
SSB CHSI-EVAL 04/22/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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