View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Application Packets for Real Property for Public Health Purposes
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
40 CFR 1500-1508 45 CFR 12-12a (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Application
HHS Off Site Application 4.2018.pdf
No
Paper Only
Other-Application
HHS Public Health Application 12.2020.pdf
No
Paper Only
Other-Application
HHS Title V application 12.2020.pdf
No
Paper Only
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:
10
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
10
0
0
0
0
10
Annual IC Time Burden (Hours)
2,000
0
0
0
0
2,000
Annual IC Cost Burden (Dollars)
2,500
0
0
0
0
2,500
Documents for IC
Title
Document
Date Uploaded
Attachment A policy
AttachmentA.Act.pdf
12/14/2016
Attachment B policy
AttachmentBMcKinney.pdf
12/14/2016
Attachment C policy
AttachmentC.CivilAction.pdf
12/14/2016
Attachment E policy
AttachmentE.Part12.pdf
12/14/2016
Attachment F policy
AttachmentF.Pt12a.pdf
12/14/2016
Attachment G policy
AttachmentG.CEQ.pdf
12/14/2016
Attachment H policy
AttachmentH.FedRegNEPA.pdf
12/14/2016
Attachment J
AttachmentJ.Offsiteapp.pdf
12/14/2016
Attachment K
AttachmentK.hmlsuseapp.pdf
12/14/2016
Attachment L
AttachmentL.hmlsapp.pdf
12/14/2016
Attachment M
AttachmentM.Revisions.pdf
12/14/2016
Attachment N
AttachmentN.7.10.06FedReg.pdf
12/14/2016
Attachment I
HHS Public Health Application 5.2019.pdf
04/15/2021
Attachment K
HHS Title V application 6.2019.pdf
04/15/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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