Information Collection

Environmental Public Health Tracking Work Plan Template

IC 222650 under ICR 202306-0920-006 · OMB 0920-1175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1175 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1175 Environmental Public Health Tracking Work Plan Template Form and Instruction
0920-1175 Modernizing Environmental Public Health Tracking to Adva Att5B Work Plan (Redcap Form).pdf Form and Instruction
0920-1175 Modernizing Environmental Public Health Tracking to Adva Att5B Work Plan (Redcap Form).pdf Form and Instruction
Att5A - Work Plan.pdf WORPLAN IC Document
Att5A - Work Plan.pdf WORPLAN IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Environmental Public Health Tracking Work Plan Template	Agency IC Tracking Number:	0920-1175

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1175	Modernizing Environmental Public Health Tracking to Advance Enviromental Health Surveillance Work Plan Template	Att5B Work Plan (Redcap Form).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	37	7	30
Annual IC Time Burden (Hours)	777	-423	1,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
WORPLAN	Att5A - Work Plan.pdf	06/09/2023

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