Information Collection

County Health Officials

IC 195713 under ICR 201012-0920-005 · OMB 0920-0636.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0636 can be found here:

Documents and Forms

Document Name Document Type
NPT Screenshots.doc Other-Survey
1 Epi X Customer Survey Attachment 3 Epi X survey.docx Form
2 Immunization and Respiratory Diseases Attachment 4 Survey Questions. A docx.docx Form
3 Environmental Health Attachment 5 questions NCHE_ATSDR mtw 17 Sept. A docx.docx Form
4 Arborviral Diseases Attachment 6 Survey Questions_Arboviral Diseases .doc Form
5 Global Migration and Quarantine Attachment 7 DGMQ Questions mtw 17 Sept. A docx.docx Form
6 Rabies Attachment 8 Rabies.docx Form
7 Health Quality Promotion Attachment 9 Div Hty Quality Questions.docx Form
Attachment 10 webpage privacy policy.docx Attachment 10 webpage privacy policy IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	County Health Officials	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			NPT Screenshots.doc	Yes	Yes	Fillable Printable
Form	1	Epi X Customer Survey	Attachment 3 Epi X survey.docx	Yes	Yes	Fillable Fileable
Form	2	Immunization and Respiratory Diseases	Attachment 4 Survey Questions. A docx.docx	Yes	Yes	Fillable Fileable
Form	3	Environmental Health	Attachment 5 questions NCHE_ATSDR mtw 17 Sept. A docx.docx	Yes	Yes	Fillable Fileable
Form	4	Arborviral Diseases	Attachment 6 Survey Questions_Arboviral Diseases .doc	Yes	Yes	Fillable Fileable
Form	5	Global Migration and Quarantine	Attachment 7 DGMQ Questions mtw 17 Sept. A docx.docx	Yes	Yes	Fillable Fileable
Form	6	Rabies	Attachment 8 Rabies.docx	Yes	Yes	Fillable Fileable
Form	7	Health Quality Promotion	Attachment 9 Div Hty Quality Questions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19,200	19,200
Annual IC Time Burden (Hours)	19,200	19,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 10 webpage privacy policy	Attachment 10 webpage privacy policy.docx	11/15/2010

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