View Information Collection (IC)

View Information Collection (IC)

IC Title:	Environmental Public Health Tracking Work Plan Template	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	NA	Program Management Tool (New Awardees) Form	Att5a_ProgramManagmentTool_Form.doc	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1175	Environmental Public Health Tracking Work Plan Template	Attachment5a_REVISEDJul2018.Environmental Public Health Tracking Work Plan Template (clean).xlsx	NA	Yes	Yes	Fillable Fileable

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: 26	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	52	0	-52	0	0	104
Annual IC Time Burden (Hours)	1,560	0	-520	0	0	2,080
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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