Information Collection

User feedback revised Office of Climate Change and Health Equity website

IC 266104 under ICR 202409-0990-001 · OMB 0990-0379.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
UXdraft.docx	Other-Qualitative data collection in
UXdraft.docx	Other-Qualitative data collection in
Qualitativesubmission_memo.docx Memo	IC Document
Qualitativesubmission_memo.docx Memo	IC Document

IC Title:

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
Other-Qualitative data collection instrument/process					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 15 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo		03/22/2024

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

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