Information Collection

2018 Public Health Ethics Forum

IC 232985 under ICR 201605-0920-001 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 2018 Public Health Ethics Forum	Form and Instruction
0920-1050 PHE Forum Survey Attachment A.docx omhhe.az1.qualtrics.com/jfe/form/SV_8k8IrX1WcWZJH3D	Form and Instruction
2018 Public Health Ethics Forum (PHEF) genIC - 9-7-18.docx PHE Forum Generic Template	IC Document
Attachment B.docx Email template	IC Document
Attachment C.docx Qualtrics Survey Options	IC Document
Attachment D.docx Forum Agenda	IC Document

IC Title:

2018 Public Health Ethics Forum

Agency IC Tracking Number:

0920-1050-18AZU

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
Form and Instruction	0920-1050	PHE Forum Survey	Attachment A.docx	https://omhhe.az1.qualtrics.com/jfe/form/SV_8k8IrX1WcWZJH3D	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PHE Forum Generic Template	2018 Public Health Ethics Forum (PHEF) genIC - 9-7-18.docx	09/12/2018
Email template	Attachment B.docx	09/12/2018
Qualtrics Survey Options	Attachment C.docx	09/12/2018
Forum Agenda	Attachment D.docx	09/12/2018

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