Information Collection

Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment

IC 212871 under ICR 201402-0920-018 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment	Form
Vector Control Assessment H_Self-assessment Instrument.doc	Form
Water Toolkit Assessment D_Assessmt Instrument Web.docx	Form
Water Feedback F_Feedback Tool Web.docx	Form
IUD0-VC-PI-SSA.docx Vector Control SS Part A	IC Document
IUD0-VC-PI-SSB.docx Vector Control SS Part B	IC Document
A_WNV Cases.pdf Vector Control Att A	IC Document
B_Vector Ctrl Capacity.pdf Vector Control Att B	IC Document
C_Budget Cuts.pdf Vector Control Att C	IC Document
D_Vector Ctrl Needs.pdf Vector Control Att D	IC Document
E_NPHPSP Factsheet.pdf Vector Control Att E	IC Document
F_EnvPHPS_PI.pdf Vector Control Att F	IC Document
G_EnvPHPS Descript.pdf Vector Control Att G	IC Document
I_Invitation Email.doc Vector Control Att I	IC Document
J_Reminder Email.doc Vector Control Att J	IC Document
XXH8-SHB-WATER-SSA.docx Water Toolkit SS Part A	IC Document
XXH8-SHB-WATER-SSB.docx Water Toolkit SS Part B	IC Document
A_Water Availability.pdf Water Tooklit Att A	IC Document
B_Water Toolkit.pdf Water Toolkit Att B	IC Document
C_Assessmt Instrument Word.docx Water Toolkit Att C	IC Document
E_Feedback Tool Word.docx Water Toolkit Att E	IC Document
G_AI Notification Email.docx Water Toolkit Att G	IC Document
H_AI Reminder Email (Week 2).docx Water Toolkit Att H	IC Document
I_AI Reminder Email (Week 3).docx Water Toolkit Att I	IC Document
J_FT Notification Email.docx Water Toolkit Att J	IC Document
K_FT Reminder Email (Week 2).docx Water Toolkit Att K	IC Document
L_FT Reminder Email (Week 3).docx Water Toolkit Att L	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment

Agency IC Tracking Number:

14AUG/14AUH

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Vector Control Assessment	H_Self-assessment Instrument.doc	Yes	Yes	Fillable Fileable
Form	none	Water Toolkit Assessment	D_Assessmt Instrument Web.docx	Yes	Yes	Fillable Fileable
Form	none	Water Feedback	F_Feedback Tool Web.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 262

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	262	262
Annual IC Time Burden (Hours)	275	275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Vector Control SS Part A	IUD0-VC-PI-SSA.docx	08/28/2014
Vector Control SS Part B	IUD0-VC-PI-SSB.docx	08/28/2014
Vector Control Att A	A_WNV Cases.pdf	08/28/2014
Vector Control Att B	B_Vector Ctrl Capacity.pdf	08/28/2014
Vector Control Att C	C_Budget Cuts.pdf	08/28/2014
Vector Control Att D	D_Vector Ctrl Needs.pdf	08/28/2014
Vector Control Att E	E_NPHPSP Factsheet.pdf	08/28/2014
Vector Control Att F	F_EnvPHPS_PI.pdf	08/28/2014
Vector Control Att G	G_EnvPHPS Descript.pdf	08/28/2014
Vector Control Att I	I_Invitation Email.doc	08/28/2014
Vector Control Att J	J_Reminder Email.doc	08/28/2014
Water Toolkit SS Part A	XXH8-SHB-WATER-SSA.docx	08/28/2014
Water Toolkit SS Part B	XXH8-SHB-WATER-SSB.docx	08/28/2014
Water Tooklit Att A	A_Water Availability.pdf	08/28/2014
Water Toolkit Att B	B_Water Toolkit.pdf	08/28/2014
Water Toolkit Att C	C_Assessmt Instrument Word.docx	08/28/2014
Water Toolkit Att E	E_Feedback Tool Word.docx	08/28/2014
Water Toolkit Att G	G_AI Notification Email.docx	08/28/2014
Water Toolkit Att H	H_AI Reminder Email (Week 2).docx	08/28/2014
Water Toolkit Att I	I_AI Reminder Email (Week 3).docx	08/28/2014
Water Toolkit Att J	J_FT Notification Email.docx	08/28/2014
Water Toolkit Att K	K_FT Reminder Email (Week 2).docx	08/28/2014
Water Toolkit Att L	L_FT Reminder Email (Week 3).docx	08/28/2014

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