Information Collection

Ph Law

IC 213235 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⚠️ Notice: This information collection may be referencing outdated material.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
D_Instrument Word Version.docx	Other-WORD
E_Instrument Web Version.docx	Other-Screen Shots
XEU3-PHELC-EVAL-SSA.docx Supporting Statement	IC Document
XEU3-PHELC-EVAL-SSB.docx Supporting Statement B	IC Document
A_PHEP Capabilities.pdf Att A PHEP Capabilities	IC Document
B_2008 National Action Agenda.pdf Att B 2008 National Action Agenda	IC Document
C_PHEL Competencies v. 1.0.pdf Att C PHEL Competencies v.1.0	IC Document
F_Invitation Email.docx Att F Invitation Email	IC Document
G_Reminder Email.docx Att G Reminder Email	IC Document

IC Title:

PH LAW

Agency IC Tracking Number:

14AZP

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			D_Instrument Word Version.docx		No		Printable Only
Other-Screen Shots			E_Instrument Web Version.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,522

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	1,522	1,522
Annual IC Time Burden (Hours)	152	152
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.