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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges
Agency IC Tracking Number:
0920-0879-18ADE
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
0920-0879
Telephone Interview Guide
Attachment D_Telephone Interview Guide.docx
NA
No
Fillable Fileable
Form and Instruction
0920-0879
Online Survey Instrument_Web version
Attachment C_Online Survey Instrument_Web version.pdf
na
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
88
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
88
0
88
0
0
0
Annual IC Time Burden (Hours)
23
0
23
0
0
0
Annual IC Cost Burden (Dollars)
1,067
0
1,067
0
0
0
Documents for IC
Title
Document
Date Uploaded
List of Big City Health Coalition Members
Attachment A_List of Big City Health Coalition Members.docx
05/04/2018
Online Survey Invitation Email
Attachment E_Online Survey Invitation Email.docx
05/04/2018
Online Survery Reminder Email 1
Attachment F_Online Survey Reminder Email 1.docx
05/04/2018
Online Survery Reminder Email 2
Attachment G_Online Survey Reminder Email 2.docx
05/04/2018
Telephone Interview Invitation Email
Attachment H_Telephone Interview Invitation Email.docx
05/04/2018
Telephone Interview Reminder Email
Attachment I_Telephone Interview Reminder Email.docx
05/04/2018
Supporting Statement A
PHE-AT-HD-SSA.DOCX
05/04/2018
Supporting Statement B
PHE-AT-HD-SSB.DOCX
05/04/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.