Information Collection

[ATSDR] Heat and Health Tracker Evaluation Survey

IC 259022 under ICR 202110-0923-002 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920 [ATSDR] Heat and Health Tracker Evaluation Survey	Form and Instruction
AttB_HHT Evaluation Survey (Word).docx	Other-WORD
0920 Page 1 Heat and Health Tracker Evaluation Survey AttB_HHT Evaluation Survey (REDCap).pdf	Form and Instruction
AttA_Email Invitation HHT Evaluation Survey.docx Email Invitation to HHT Evaluation Survey	IC Document
AttC_STARS Determination.pdf HHT STARS Determination	IC Document
GenIC Rqst 0923-0047 HHT Evaluation Survey.docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”	IC Document

IC Title:

[ATSDR] Heat and Health Tracker Evaluation Survey

Agency IC Tracking Number:

0923-0047-23DN

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 and Instruction	0920	Page 1 Heat and Health Tracker Evaluation Survey	AttB_HHT Evaluation Survey (REDCap).pdf		Yes	Yes	Fillable Fileable
Other-WORD			AttB_HHT Evaluation Survey (Word).docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 71

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	71	71
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation to HHT Evaluation Survey	AttA_Email Invitation HHT Evaluation Survey.docx	03/09/2023
HHT STARS Determination	AttC_STARS Determination.pdf	03/09/2023
Request for Approval under the âGeneric Clearance for the Collection of Routine Customer Feedbackâ	GenIC Rqst 0923-0047 HHT Evaluation Survey.docx	03/09/2023

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