Information Collection

State and Local Environmental Public Health Employees Usage of Public Health Assessments and Consultations Documents

IC 205658 under ICR 201110-0920-004 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ATSDR Attachment F Clearance Process Evaluation Executive Summary.docx	Instruction
ATSDR Attachment G Community Report Redesign_A.pdf	Instruction
ATSDR Attachment J Phone Screener.doc	Instruction
ATSDR Attachment H Health Consultation Brochure Redesign_B.ppt	Instruction
ATSDR Attachment I HC Redesign Template_C.pdf	Instruction
ATSDR Attachment K Focus Group Data Collection Tool.doc	Instruction
ATSDR Attachment L FOCUS GROUP CONFIRMATION EMAIL.docx	Instruction
ATSDR Attachment M Focus Group Reminder Script.docx	Instruction
ATSDR Supporting_Statement_B.docx ATSDR Supporting_Statement_B	IC Document
ATSDR Attachment A CERCLA Authorizing Legislation.pdf ATSDR Attachment A CERCLA Authorizing Legislation	IC Document
ATSDR Attachment B RCRA Legislation.pdf ATSDR Attachment B RCRA Legislation	IC Document
ATSDR Attachment C National Priorities List.docx ATSDR Attachment C National Priorities List	IC Document
ATSDR Attachment D Oak Ridge Y-12_PHA.pdf ATSDR Attachment D Oak Ridge Y-12_PHA	IC Document
ATSDR Attachment E MidlothianAreaAirQuality_HC.pdf ATSDR Attachment E MidlothianAreaAirQuality_HC	IC Document
ATSDR Supporting_Statement_A.docx ATSDR Supporting_Statement_A	IC Document

IC Title:

State and Local Environmental Public Health Employees Usage of Public Health Assessments and Consultations Documents

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	ATSDR Attachment F Clearance Process Evaluation Executive Summary.docx	Yes	Yes	Fillable Printable
Instruction	ATSDR Attachment G Community Report Redesign_A.pdf	Yes	Yes	Printable Only
Instruction	ATSDR Attachment J Phone Screener.doc	Yes	Yes	Printable Only
Instruction	ATSDR Attachment H Health Consultation Brochure Redesign_B.ppt	Yes	Yes	Printable Only
Instruction	ATSDR Attachment I HC Redesign Template_C.pdf	Yes	Yes	Printable Only
Instruction	ATSDR Attachment K Focus Group Data Collection Tool.doc	Yes	Yes	Printable Only
Instruction	ATSDR Attachment L FOCUS GROUP CONFIRMATION EMAIL.docx	Yes	Yes	Printable Only
Instruction	ATSDR Attachment M Focus Group Reminder Script.docx	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	150	0	0	0	0	0
Annual IC Time Burden (Hours)	125	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ATSDR Supporting_Statement_B	ATSDR Supporting_Statement_B.docx	01/15/2013
ATSDR Attachment A CERCLA Authorizing Legislation	ATSDR Attachment A CERCLA Authorizing Legislation.pdf	01/15/2013
ATSDR Attachment B RCRA Legislation	ATSDR Attachment B RCRA Legislation.pdf	01/15/2013
ATSDR Attachment C National Priorities List	ATSDR Attachment C National Priorities List.docx	01/15/2013
ATSDR Attachment D Oak Ridge Y-12_PHA	ATSDR Attachment D Oak Ridge Y-12_PHA.pdf	01/15/2013
ATSDR Attachment E MidlothianAreaAirQuality_HC	ATSDR Attachment E MidlothianAreaAirQuality_HC.pdf	01/15/2013
ATSDR Supporting_Statement_A	ATSDR Supporting_Statement_A.docx	01/22/2013

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