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

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.