OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Individuals and Households)

IC 230700 under ICR 202104-0925-001 · OMB 0925-0648.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Individuals and Households)
 
Unchanged
 
Mandatory
 

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 (4).docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

292 0
   
Individuals or Households
 
   100 %

  Requested 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 292 0 0 0 0 292
Annual IC Time Burden (Hours) 24 0 0 0 0 24
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Partnerships for Environmental Public Health (PEPH) Aware-Act-Use PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2 (4).docx 03/13/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.