Information Collection

Interview Recruitment Screener for State Environmental Health Professionals

IC 209782 under ICR 201312-0923-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att4a_Int_RecScrnr_SEHP_PCCDIR.doc	Other-WORD
Att3a_Intro_Email_Ints.docx Att3a_Intro_Email_Ints	IC Document
Att5a_Conf_Email_Ints.docx Att5a_Conf_Email_Ints	IC Document
Att6a_Remind_Email_Ints.docx Att6a_Remind_Email_Ints	IC Document
Att10b_Inf_Cnsnt_Ints.docx Att10b_Inf_Cnsnt_Ints	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att4a_Int_RecScrnr_SEHP_PCCDIR.doc		Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7	7
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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