Local Health Department Capacity and Readiness

Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Document Name Document Type
Local Health Department Capacity and Readiness Form
Local Health Department Capacity and Readiness Atmt_SS_Local_Health_Department_Capacity_and_Readiness_Survey[1].docx Form

Information Collection (IC) Details

IC Title:	Local Health Department Capacity and Readiness	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Form	None	Local Health Department Capacity and Readiness	Atmt_SS_Local_Health_Department_Capacity_and_Readiness_Survey[1].docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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