Information Collection

Understanding Changes to Local Health Department Clinical Service Provision

IC 218907 under ICR 201704-0990-001 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ASPE_IP_draft_final.pdf	Other-survey
0990-0421OMB Cover Sheet_LHD Pos Dev_10-13-15.pdf Understanding Changes to Local Health Department Clinical Service Provision	IC Document
SS A_LHD.pdf Suppt A_Understanding Changes to Local Health Department Clinical Service Provision	IC Document
0990-0421 SS B_LHD_Pos dev_ASPE.pdf Suppt B_Understanding Changes to Local Health Department Clinical Service Provision	IC Document

IC Title:

Understanding Changes to Local Health Department Clinical Service Provision

Agency IC Tracking Number:

IC Status: Unchanged

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
Other-survey					No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Understanding Changes to Local Health Department Clinical Service Provision		11/09/2015
Suppt A_Understanding Changes to Local Health Department Clinical Service Provision		12/09/2015
Suppt B_Understanding Changes to Local Health Department Clinical Service Provision		11/09/2015

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

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