Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0879 Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges Form and Instruction
0920-0879 Telephone Interview Guide Attachment D_Telephone Interview Guide.docx Form and Instruction
0920-0879 Online Survey Instrument_Web version Attachment C_Online Survey Instrument_Web version.pdf Form and Instruction
Attachment A_List of Big City Health Coalition Members.docx List of Big City Health Coalition Members IC Document
Attachment E_Online Survey Invitation Email.docx Online Survey Invitation Email IC Document
Attachment F_Online Survey Reminder Email 1.docx Online Survery Reminder Email 1 IC Document
Attachment G_Online Survey Reminder Email 2.docx Online Survery Reminder Email 2 IC Document
Attachment H_Telephone Interview Invitation Email.docx Telephone Interview Invitation Email IC Document
Attachment I_Telephone Interview Reminder Email.docx Telephone Interview Reminder Email IC Document
PHE-AT-HD-SSA.DOCX Supporting Statement A IC Document
PHE-AT-HD-SSB.DOCX Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges	Agency IC Tracking Number:	0920-0879-18ADE

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	0920-0879	Online Survey Instrument_Web version	Attachment C_Online Survey Instrument_Web version.pdf	na	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Telephone Interview Guide	Attachment D_Telephone Interview Guide.docx	NA	No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 88	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	88	88
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	1,067	1,067

Documents for IC

Title	Document	Date Uploaded
List of Big City Health Coalition Members	Attachment A_List of Big City Health Coalition Members.docx	05/04/2018
Online Survey Invitation Email	Attachment E_Online Survey Invitation Email.docx	05/04/2018
Online Survery Reminder Email 1	Attachment F_Online Survey Reminder Email 1.docx	05/04/2018
Online Survery Reminder Email 2	Attachment G_Online Survey Reminder Email 2.docx	05/04/2018
Telephone Interview Invitation Email	Attachment H_Telephone Interview Invitation Email.docx	05/04/2018
Telephone Interview Reminder Email	Attachment I_Telephone Interview Reminder Email.docx	05/04/2018
Supporting Statement A	PHE-AT-HD-SSA.DOCX	05/04/2018
Supporting Statement B	PHE-AT-HD-SSB.DOCX	05/04/2018

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