Information Collection

Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households)

IC 230405 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households) Form
1 PEPH Aware-Act-Use instrument PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2.docx Form
Fast Track _PEPH Ind. and Households.docx PEPH Aware-Act-Use IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Partnerships for Environmental Public Health Program (PEPH) Aware-Act-Use Survey (Individuals/households)	Agency IC Tracking Number:

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	1	PEPH Aware-Act-Use instrument	PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 292	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	292	292
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PEPH Aware-Act-Use	Fast Track _PEPH Ind. and Households.docx	03/06/2018

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