Document Name Document Type
Evaluating the Health Hazard Evaluation Program's Communication with Local Health Departments Form
Survey (Word) HHE local health department survey Attachment G - Data collection instrument (Word).docx Form
Survey (Web) HHE local health department survey Attachment F - Data collection instrument (web).pdf Form
HHE local health department survey supporting statement Part A.docx SS Part A IC Document
HHE local health department survey Attachment B - Example of an HHE report.pdf Example Report IC Document
HHE local health department survey Attachment C - National Academies brief report.pdf National Academies Report IC Document
HHE local health department survey Attachment D - Implementation Plan.pdf Implementation Plan IC Document
HHE local health department survey Attachment E - HHE Strategic Plan FY2012.pdf Strategic Plan IC Document
HHE local health department survey Attachment J- Sample Report.docx Sample Report IC Document
HHE local health department survey Attachment K - Web links to local health department listings.docx Web Links to Local Health Depts IC Document
HHE local health department survey Attachment L - Population served NACCHO report.pdf NACCHO Report IC Document
HHE local health department survey Attachment A - NOA_0920-0260 11-2011.pdf NOA 0920-0260 IC Document
HHE local health department survey Attachment H - Survey invitation email.docx Email Invitation IC Document
HHE local health department survey Attachment I - Survey invitation email reminders.docx Email Reminder IC Document
HHE local health department survey supporting statement Part B.docx SS Part B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluating the Health Hazard Evaluation Program's Communication with Local Health Departments	Agency IC Tracking Number:

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	none	Survey (Word)	HHE local health department survey Attachment G - Data collection instrument (Word).docx		Yes	Yes	Fillable Fileable
Form	none	Survey (Web)	HHE local health department survey Attachment F - Data collection instrument (web).pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	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	52	0	0	0	0	0
Annual IC Time Burden (Hours)	9	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SS Part A	HHE local health department survey supporting statement Part A.docx	06/04/2012
Example Report	HHE local health department survey Attachment B - Example of an HHE report.pdf	06/04/2012
National Academies Report	HHE local health department survey Attachment C - National Academies brief report.pdf	06/04/2012
Implementation Plan	HHE local health department survey Attachment D - Implementation Plan.pdf	06/04/2012
Strategic Plan	HHE local health department survey Attachment E - HHE Strategic Plan FY2012.pdf	06/04/2012
Sample Report	HHE local health department survey Attachment J- Sample Report.docx	06/04/2012
Web Links to Local Health Depts	HHE local health department survey Attachment K - Web links to local health department listings.docx	06/04/2012
NACCHO Report	HHE local health department survey Attachment L - Population served NACCHO report.pdf	06/04/2012
NOA 0920-0260	HHE local health department survey Attachment A - NOA_0920-0260 11-2011.pdf	06/04/2012
Email Invitation	HHE local health department survey Attachment H - Survey invitation email.docx	06/04/2012
Email Reminder	HHE local health department survey Attachment I - Survey invitation email reminders.docx	06/04/2012
SS Part B	HHE local health department survey supporting statement Part B.docx	06/04/2012

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

Evaluating the Health Hazard Evaluation Program's Communication with Local Health Departments

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

OMB: 0920-0879

IC ID: 202600

View Information Collection (IC)