Information Collection

Environmental Health Language Collaborative Survey (NIEHS)

IC 247553 under ICR 202109-0925-004 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Environmental Health Language Collaborative Survey (NIEHS)	Form
Form 1 Environmental Health Language Collaborative Survey (NIEHS)	Form
1 Use cases survey NIEHS_EHLC_Survey Clearance Request_Use cases Survey 0925-0766.docx	Form
1 Use cases survey NIEHS_EHLC_Survey Clearance Request_Use cases Survey 0925-0766.docx	Form
2 Community survey NIEHS_EHLC_Survey Clearance Request_Community Survey 0925-0766 (1).docx	Form
2 Community survey NIEHS_EHLC_Survey Clearance Request_Community Survey 0925-0766 (1).docx	Form
NIEHS_EHLC_Survey Clearance 0925-0766 2021-05-17 (1).docx Environmental Health Language Collaborative Survey (NIEHS)	IC Document
NIEHS_EHLC_Survey Clearance 0925-0766 2021-05-17 (1).docx Environmental Health Language Collaborative Survey (NIEHS)	IC Document
NIEHS_EHLC_SurveyMonkey_Email_0925-0766.docx Survey Monkey email invite	IC Document
NIEHS_EHLC_SurveyMonkey_Email_0925-0766.docx Survey Monkey email invite	IC Document

IC Title:

Environmental Health Language Collaborative Survey (NIEHS)

Agency IC Tracking Number:

IC Status: Unchanged

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	Use cases survey	NIEHS_EHLC_Survey Clearance Request_Use cases Survey 0925-0766.docx		Yes	Yes	Fillable Fileable
Form	2	Community survey	NIEHS_EHLC_Survey Clearance Request_Community Survey 0925-0766 (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Environmental Health Language Collaborative Survey (NIEHS)	NIEHS_EHLC_Survey Clearance 0925-0766 2021-05-17 (1).docx	05/21/2021
Survey Monkey email invite	NIEHS_EHLC_SurveyMonkey_Email_0925-0766.docx	05/21/2021

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