Information Collection

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households (NIEHS)

IC 246516 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households (NIEHS)	Form
1 PEPH Aware Act Use survey PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx	Form
Fast Track _PEPH Ind. and Households.docx fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use – Individuals/households	IC Document

IC Title:

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use â Individuals/households (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	PEPH Aware Act Use survey	PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 292

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	292	292
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for Partnerships for Environmental Public Health (PEPH) Aware-Act-Use â Individuals/households	Fast Track _PEPH Ind. and Households.docx	03/31/2021

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