Information Collection

Environmental Health Disparities and Women's Reproductive Health Workshop Survey (NIEHS)

IC 253199 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⚠️ Notice: This information collection may be referencing outdated material.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 Disparities and Women's Reproductive Health Workshop Survey (NIEHS)	Form
1 EHD Day 1 survey EHD Day 1 Customer Satisfaction Survey (1).docx	Form
2 EHD Day 2 EHD Day 2 Customer Satisfaction Survey (1).docx	Form
0925-0648 NIEHS EHD Workshop survey clearance_rev 04-27-2022.docx Fast track for EHD Workshop feedback	IC Document

IC Title:

Environmental Health Disparities and Women's Reproductive Health Workshop 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	EHD Day 1 survey	EHD Day 1 Customer Satisfaction Survey (1).docx		Yes	Yes	Fillable Fileable
Form	2	EHD Day 2	EHD Day 2 Customer Satisfaction Survey (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track for EHD Workshop feedback	0925-0648 NIEHS EHD Workshop survey clearance_rev 04-27-2022.docx	05/03/2022

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