Information Collection

Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions

IC 268129 under ICR 202404-2030-001 · OMB 2030-0051.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6700-032 Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions	Form and Instruction
HIA Training Focus Group Activity.docx	Instruction
HIA Training Focus Group Activity.docx	Instruction
6700-032 HIA Training Feedback Storytelling Activity HIA Training Feedback Storytelling Activity.docx	Form and Instruction
6700-032 HIA Training Feedback Storytelling Activity HIA Training Feedback Storytelling Activity.docx	Form and Instruction
CCBH_Justification for Generic Customer Service Collection Request.docx Justification	IC Document
CCBH_Justification for Generic Customer Service Collection Request.docx Justification	IC Document

IC Title:

Agency IC Tracking Number:

2434.274

IC Status: New

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 and Instruction	6700-032	HIA Training Feedback Storytelling Activity	HIA Training Feedback Storytelling Activity.docx		No		Printable Only
Instruction			HIA Training Focus Group Activity.docx		No		Printable Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	CCBH_Justification for Generic Customer Service Collection Request.docx	05/30/2024

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