Information Collection

Understanding Changes to Local Health Department Clinical Service Provision

IC 218907 under ICR 201403-0990-004 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ASPE_IP_draft_final.pdf	Other-survey
0990-0421OMB Cover Sheet_LHD Pos Dev_10-13-15.pdf Understanding Changes to Local Health Department Clinical Service Provision	IC Document
SS A_LHD.pdf Suppt A_Understanding Changes to Local Health Department Clinical Service Provision	IC Document
0990-0421 SS B_LHD_Pos dev_ASPE.pdf Suppt B_Understanding Changes to Local Health Department Clinical Service Provision	IC Document

IC Title:

Understanding Changes to Local Health Department Clinical Service Provision

Agency IC Tracking Number:

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-survey			ASPE_IP_draft_final.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Understanding Changes to Local Health Department Clinical Service Provision	0990-0421OMB Cover Sheet_LHD Pos Dev_10-13-15.pdf	11/09/2015
Suppt A_Understanding Changes to Local Health Department Clinical Service Provision	SS A_LHD.pdf	12/09/2015
Suppt B_Understanding Changes to Local Health Department Clinical Service Provision	0990-0421 SS B_LHD_Pos dev_ASPE.pdf	11/09/2015

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