Information Collection

Environmental Health Equity through Implementation Science Workshop Feedback survey (NIEHS)

IC 251598 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⚠️ Notice: This information collection may be referencing outdated material.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 Environmental Health Equity through Implementation Science Workshop Feedback survey (NIEHS)	Form
1 EHS ImpSci Survey EHE ImpSci Workshop Survey _ MS Forms Screenshots 2-11-2022.docx	Form
EHE IS Workshop Survey_generic_clearance_template_ 02-11-2022 Clean (3).docx Fast track for Environmental Health Equity Implementation Science Workshop Feedback	IC Document
Launching survey.docx invitation	IC Document

IC Title:

Environmental Health Equity through Implementation Science Workshop Feedback survey (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	EHS ImpSci Survey	EHE ImpSci Workshop Survey _ MS Forms Screenshots 2-11-2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track for Environmental Health Equity Implementation Science Workshop Feedback	EHE IS Workshop Survey_generic_clearance_template_ 02-11-2022 Clean (3).docx	02/14/2022
invitation	Launching survey.docx	02/14/2022

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