BE Review (Built Environment) Healthy Community Design: Assessment of Local Health and Planning Departments

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⚠️ Notice: This information collection may be referencing outdated material.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
BE Review (Built Environment) Healthy Community Design: Assessment of Local Health and Planning Departments Form and Instruction
LHD Instrument - Web B_LHD Instrument Web.docx Form and Instruction
Planner Instrument E_Planner Instrument Web.docx Form and Instruction
1 HGQ8-BE-REVIEW-SSA.docx Supporting Statement A IC Document
2 HGQ8-BE-REVIEW-SSB.docx Supporting Statement B IC Document
C_LHD Instrument Word.docx LHD Instrument - WORD IC Document
D_Planner Instrument Word.docx Planner Instrument - WORD IC Document
A_2004 Assessment Report.pdf 2004 Assessment Report IC Document
F_APA Advance Email.docx APA Advance Email IC Document
G_NACCHO Advance Email.docx NACCHO Advance Email IC Document
H_Reminder Email_Non-response 10 Day APA.docx Reminder Email Non-Response 10 Day APA IC Document
I_Reminder Email_Non-response 10 Days NACCHO.docx Reminder Emial Non-Response 10 Day NACCHO IC Document
J_Reminder Email_Non-response 15 Day APA.docx Reminder Email Non-Response 15 Day APA IC Document
K_Reminder Email_Non-response 15 Days NACCHO.docx Reminder Email Non-Response 15 Day NACCHO IC Document
L_ Reminder Email 10 Days Partial APA.docx Reminder Email 10 Day Partial APA IC Document
M_ Reminder Email 10 Days Partial NACCHO.docx Reminder Email 10 Day Partial NACCHO IC Document
N_ Reminder Email 15 Days Partial APA.docx Reminder Email 15 Day Partial APA IC Document
O_ Reminder Email 15 Days Partial NACCHO.docx Reminder Email 15 Day Partial NACCHO IC Document

Information Collection (IC) Details

IC Title:	BE Review (Built Environment) Healthy Community Design: Assessment of Local Health and Planning Departments	Agency IC Tracking Number:	15SB

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
Form and Instruction	None	LHD Instrument - Web	B_LHD Instrument Web.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Planner Instrument	E_Planner Instrument Web.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,130	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	1,130	1,130
Annual IC Time Burden (Hours)	283	283
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	1 HGQ8-BE-REVIEW-SSA.docx	03/06/2015
Supporting Statement B	2 HGQ8-BE-REVIEW-SSB.docx	03/06/2015
LHD Instrument - WORD	C_LHD Instrument Word.docx	03/06/2015
Planner Instrument - WORD	D_Planner Instrument Word.docx	03/06/2015
2004 Assessment Report	A_2004 Assessment Report.pdf	03/06/2015
APA Advance Email	F_APA Advance Email.docx	03/06/2015
NACCHO Advance Email	G_NACCHO Advance Email.docx	03/06/2015
Reminder Email Non-Response 10 Day APA	H_Reminder Email_Non-response 10 Day APA.docx	03/06/2015
Reminder Emial Non-Response 10 Day NACCHO	I_Reminder Email_Non-response 10 Days NACCHO.docx	03/06/2015
Reminder Email Non-Response 15 Day APA	J_Reminder Email_Non-response 15 Day APA.docx	03/06/2015
Reminder Email Non-Response 15 Day NACCHO	K_Reminder Email_Non-response 15 Days NACCHO.docx	03/06/2015
Reminder Email 10 Day Partial APA	L_ Reminder Email 10 Days Partial APA.docx	03/06/2015
Reminder Email 10 Day Partial NACCHO	M_ Reminder Email 10 Days Partial NACCHO.docx	03/06/2015
Reminder Email 15 Day Partial APA	N_ Reminder Email 15 Days Partial APA.docx	03/06/2015
Reminder Email 15 Day Partial NACCHO	O_ Reminder Email 15 Days Partial NACCHO.docx	03/06/2015

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