Information Collection

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)

IC 230702 under ICR 201906-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 1 Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)	Form and Instruction
1 PEPH Aware Act Use Survey Final PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2 (2).docx	Form and Instruction
Fast Track _PEPH State and Local.docx Partnerships for Environmental Public Health (PEPH) Aware-Act-Use	IC Document

IC Title:

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)

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
Form and Instruction	1	PEPH Aware Act Use Survey Final	PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2 (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use	Fast Track _PEPH State and Local.docx	03/13/2018

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