Information Collection

Public Health Nursing Data Mart Survey

IC 225048 under ICR 202201-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036 Public Health Nursing Data Mart Survey	Form and Instruction
0917-0036 Public Health Nursing (PHN) Data Mart Survey Questions PHN Data Mart survey Questions.docx	Form and Instruction
0917-0036 Public Health Nursing (PHN) Data Mart Survey Questions PHN Data Mart survey Questions.docx	Form and Instruction
Generic Clearance Submission - Public Health Nursing Data Mart.doc Request for Approval - Public Health Nursing (PHN) Data Mart Survey Questions	IC Document
Generic Clearance Submission - Public Health Nursing Data Mart.doc Request for Approval - Public Health Nursing (PHN) Data Mart Survey Questions	IC Document

IC Title:

Public Health Nursing Data Mart Survey

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 and Instruction	0917-0036	Public Health Nursing (PHN) Data Mart Survey Questions	PHN Data Mart survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 123

Number of Respondents for Small Entity: 1

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	123	123
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval - Public Health Nursing (PHN) Data Mart Survey Questions	Generic Clearance Submission - Public Health Nursing Data Mart.doc	01/06/2017

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