Information Collection

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households (NIEHS)

IC 246516 under ICR 202103-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 – Individuals/households (NIEHS)	Form
1 PEPH Aware Act Use survey PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx	Form
1 PEPH Aware Act Use survey PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx	Form
Fast Track _PEPH Ind. and Households.docx fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households	IC Document
Fast Track _PEPH Ind. and Households.docx fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households	IC Document

IC Title:

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use â Individuals/households (NIEHS)

Agency IC Tracking Number:

IC Status: New

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	1	PEPH Aware Act Use survey	PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 292

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	292	292
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use â Individuals/households	Fast Track _PEPH Ind. and Households.docx	03/31/2021

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