Information Collection

Reaccredited health departments

IC 239114 under ICR 201912-0920-015 · OMB 0920-1295.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1295 can be found here:

Documents and Forms

Document Name Document Type
Reaccredited health departments Form
Reaccredited health departments AttachmentK_Survey5-Screenshot.pdf Form
AttachmentS_Survey5-Invitation.docx Survey invitation IC Document
AttachmentX_Survey5-Reminder.docx Survey reminder IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reaccredited health departments	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Reaccredited health departments	AttachmentK_Survey5-Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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	60	60
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	814	814

Documents for IC

Title	Document	Date Uploaded
Survey invitation	AttachmentS_Survey5-Invitation.docx	12/30/2019
Survey reminder	AttachmentX_Survey5-Reminder.docx	12/30/2019

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