Ph Law

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

IC Title:	PH LAW	Agency IC Tracking Number:	14AZP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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.