ATSDR Health Education Activity Tracking (HEAT) Form

APPLETREE Performance Measures

OMB: 0923-0057

IC ID: 226334

Information Collection (IC) Details

View Information Collection (IC)

ATSDR Health Education Activity Tracking (HEAT) Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Health Education (screenshots) with COVID-19 question Att4a ATSDR HEAT Form_SharePoint_COVID-19 20200909.pdf Yes Yes Fillable Fileable
Other-WORD document to display instrument content Att4a ATSDR HEAT Form_Word_COVID-19 20200909.docx No   Paper Only

Health Consumer Health and Safety

 

28 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,036 0 0 0 0 1,036
Annual IC Time Burden (Hours) 52 0 0 0 0 52
Annual IC Cost Burden (Dollars) 1,932 0 0 0 0 1,932

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