Information Collection Request

[NCEH] Environmental Public Health Tracking Network (Tracking Network)

ICR 202306-0920-006 · OMB 0920-1175 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1175 PA/PHA Impact Followup Form and Instruction New Available
Form 0920-1175 PHA Impact Follow Up - (RedCap form) (New form) Form and Instruction New Repair queued
Form 0920-1175 Performance Measurses - Unique Form and Instruction Modified Available
Form 0920-1175 Performance Measures- Unique Form and Instruction Modified Repair queued
Form 0920-1175 Standardized Web Statistics - Codebook Form and Instruction Modified Available
Form 0920-1175 Standardized Web Statistics - Codebook Form and Instruction Modified Repair queued
Form 0920-1175 Data Dictionary- State Biomonitoring Data Form and Instruction Modified Available
Form 0920-1175 Data Dictionary- State Biomonitoring Data Form and Instruction Modified Repair queued
Form 0920-1175 Outreach & Communication Plan Template with Instructions Form and Instruction Modified Available
Form 0920-1175 Outreach & Communication Plan Template with Instructions Form and Instruction Modified Repair queued
Form 0920-1175 Program Accomplishments & Public Health Actions Form and Instruction Modified Available
Form 0920-1175 Publilc Health Action Report - Existing Awardees Form and Instruction Modified Repair queued
Form 0920-1175 Modernizing Environmental Public Health Tracking to Advance Enviromental Health Surveillance Work Plan Template Form and Instruction Modified Available
Form 0920-1175 Environmental Public Health Tracking Work Plan Template Form and Instruction Modified Repair queued
Form 0920-1175 Metadata Sample Content Form and Instruction Modified Available
Form 0920-1175 Metadata Sample Content Form and Instruction Modified Repair queued
Form 0920-1175 Radon Testing Form Form and Instruction Modified Available
Form 0920-1175 Data Dictionary for Data Submission -- Labs Radon Data Form and Instruction Modified Repair queued
Form 0920-1175 Data Dictionary- Hospitalizations Form and Instruction Modified Available
Form 0920-1175 Data Dictionary- Hospitalizations Form and Instruction Modified Repair queued
Form 0920-1175 Data Dictionary - Emergency Department (ED) Visits Form and Instruction Modified Available
Form 0920-1175 Data Dictionary - Emergency Department (ED) Visits Form and Instruction Modified Repair queued
Form 0920-1175 Data Dictionary – Drinking Water (Community Monitoring) Form and Instruction Modified Available
Form 0920-1175 Data Dictionary – Drinking Water (Community Monitoring) Form and Instruction Modified Available
Form 0920-1175 Environmental Public Health Tracking - CHILDHOOD BLOOD LEAD POISONING Form and Instruction Modified Available
Form 0920-1175 Environment Public Health Tracking -- Childhood Blood Lead Poisoning Form and Instruction Modified Repair queued
Form 0920-1175 Data Dictionary -- Birth Defects(Prevalence) Form and Instruction Modified Available
Form 0920-1175 Data Dictionary – Birth Defects (Prevelance) Form Form and Instruction Modified Repair queued
Att6 CDC-RFA-EH17-1702.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att10 Data Management Processes.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att9 NCDM Requirements.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att8 Funding Determination.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att7 Environ PH Trckg 2023 Revision PIA.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att3 NOFO CDC-RFA-EH22-2202.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att2 Environ PH Trckg 60 day FRN publication.pdf Supplementary Document Uploaded 2023-07-06 Repair queued
Att1_PHSA Section 243&247.docx Supplementary Document Uploaded 2020-04-27 Missing upstream
0 - Environ PH Trckg 2023 Revision SSB.docx Supporting Statement B Uploaded 2023-07-06 Repair queued
0 - Environ PH Trckg 2023 (REV) SSA.docx Supporting Statement A Uploaded 2023-07-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
260973 PHA Impact Follow Up - (RedCap form) (New form) Form and Instruction NewPA/PHA Impact Followup
260973 PHA Impact Follow Up - (RedCap form) (New form) Form and Instruction New
241554 Performance Measures- Unique Form and Instruction ModifiedPerformance Measurses - Unique
241554 Performance Measures- Unique Form and Instruction Modified
222657 Standardized Web Statistics - Codebook Form and Instruction ModifiedStandardized Web Statistics - Codebook
222657 Standardized Web Statistics - Codebook Form and Instruction Modified
222656 Data Dictionary- State Biomonitoring Data Form and Instruction ModifiedData Dictionary- State Biomonitoring Data
222656 Data Dictionary- State Biomonitoring Data Form and Instruction Modified
222654 Outreach & Communication Plan Template with Instructions Form and Instruction ModifiedOutreach & Communication Plan Template with Instructions
222654 Outreach & Communication Plan Template with Instructions Form and Instruction Modified
222652 Publilc Health Action Report - Existing Awardees Form and Instruction ModifiedProgram Accomplishments & Public Health Actions
222652 Publilc Health Action Report - Existing Awardees Form and Instruction Modified
222650 Environmental Public Health Tracking Work Plan Template Form and Instruction ModifiedModernizing Environmental Public Health Tracking to Advance Enviromental Health Surveillance Work Plan Template
222650 Environmental Public Health Tracking Work Plan Template Form and Instruction Modified
222649 Metadata Sample Content Form and Instruction ModifiedMetadata Sample Content
222649 Metadata Sample Content Form and Instruction Modified
222648 Data Dictionary for Data Submission -- Labs Radon Data Form and Instruction ModifiedRadon Testing Form
222648 Data Dictionary for Data Submission -- Labs Radon Data Form and Instruction Modified
222646 Data Dictionary- Hospitalizations Form and Instruction ModifiedData Dictionary- Hospitalizations
222646 Data Dictionary- Hospitalizations Form and Instruction Modified
222533 Data Dictionary - Emergency Department (ED) Visits Form and Instruction ModifiedData Dictionary - Emergency Department (ED) Visits
222533 Data Dictionary - Emergency Department (ED) Visits Form and Instruction Modified
222532 Data Dictionary – Drinking Water (Community Monitoring) Form and Instruction ModifiedData Dictionary – Drinking Water (Community Monitoring)
222532 Data Dictionary – Drinking Water (Community Monitoring) Form and Instruction Modified
222531 Environment Public Health Tracking -- Childhood Blood Lead Poisoning Form and Instruction ModifiedEnvironmental Public Health Tracking - CHILDHOOD BLOOD LEAD POISONING
222531 Environment Public Health Tracking -- Childhood Blood Lead Poisoning Form and Instruction Modified
222530 Data Dictionary – Birth Defects (Prevelance) Form Form and Instruction ModifiedData Dictionary -- Birth Defects(Prevalence)
222530 Data Dictionary – Birth Defects (Prevelance) Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2026 36 Months From Approved 08/31/2023
635 0 628
14,384 0 21,860
0 0 0





Reginfo record details
14
table that charts list of burden
IC Title Form No. Form Name
Data Dictionary - Emergency Department (ED) Visits 0920-1175
Data Dictionary for Data Submission -- Labs Radon Data 0920-1175
Data Dictionary – Birth Defects (Prevelance) Form 0920-1175
Data Dictionary – Drinking Water (Community Monitoring) 0920-1175
Data Dictionary- Hospitalizations 0920-1175
Data Dictionary- State Biomonitoring Data 0920-1175
Environment Public Health Tracking -- Childhood Blood Lead Poisoning 0920-1175
Environmental Public Health Tracking Work Plan Template 0920-1175
Metadata Sample Content 0920-1175
Outreach & Communication Plan Template with Instructions 0920-1175
PHA Impact Follow Up - (RedCap form) (New form) 0920-1175
Performance Measures- Unique 0920-1175
Publilc Health Action Report - Existing Awardees 0920-1175
Standardized Web Statistics - Codebook 0920-1175

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 635 628 0 7 0 0
Annual Time Burden (Hours) 14,384 21,860 0 -7,476 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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