Information Collection

Healthy Homes and Lead Poisoning Surveillance Variables

IC 200238 under ICR 201502-0920-012 · OMB 0920-0931.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0931 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPEND_C_HHLPSS Variables 41612clean.doc	Instruction
asthmascreenshot.docx asthmascreenshot	IC Document
Patient Race with Native Hawaiian and Other Pacific Islander Combined.docx Patient Race with Native Hawaiian and Other Pacific Islander Combined	IC Document

IC Title:

Healthy Homes and Lead Poisoning Surveillance Variables

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301

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
Instruction			APPEND_C_HHLPSS Variables 41612clean.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-160	160
Annual IC Time Burden (Hours)	-640	640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
asthmascreenshot	asthmascreenshot.docx	04/19/2012
Patient Race with Native Hawaiian and Other Pacific Islander Combined	Patient Race with Native Hawaiian and Other Pacific Islander Combined.docx	04/19/2012

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