Information Collection

Environmental Health Equity through Implementation Science Workshop Feedback survey (NIEHS)

IC 251598 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⚠️ Notice: This information collection may be referencing outdated material.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 EHS ImpSci Survey Environmental Health Equity through Implementation Science Workshop Feedback survey (NIEHS)	Form
1 EHS ImpSci Survey EHE ImpSci Workshop Survey _ MS Forms Screenshots 2-11-2022.docx	Form
EHE IS Workshop Survey_generic_clearance_template_ 02-11-2022 Clean (3).docx Fast track for Environmental Health Equity Implementation Science Workshop Feedback	IC Document
Launching survey.docx invitation	IC Document

IC Title:

Environmental Health Equity through Implementation Science Workshop Feedback survey (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				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track for Environmental Health Equity Implementation Science Workshop Feedback		02/14/2022
invitation		02/14/2022

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].