Information Collection

Application Packets for Real Property for Public Health Purposes

IC 7743 under ICR 202412-0937-002 · OMB 0937-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HHS Off Site Application 4.2018.pdf	Other-Application
HHS Off Site Application 4.2018.pdf	Other-Application
HHS Public Health Application 12.2020.pdf	Other-Application
HHS Public Health Application 12.2020.pdf	Other-Application
HHS Title V application 12.2020.pdf	Other-Application
HHS Title V application 12.2020.pdf	Other-Application
AttachmentA.Act.pdf Attachment A policy	IC Document
AttachmentA.Act.pdf Attachment A policy	IC Document
AttachmentBMcKinney.pdf Attachment B policy	IC Document
AttachmentBMcKinney.pdf Attachment B policy	IC Document
AttachmentC.CivilAction.pdf Attachment C policy	IC Document
AttachmentC.CivilAction.pdf Attachment C policy	IC Document
AttachmentE.Part12.pdf Attachment E policy	IC Document
AttachmentE.Part12.pdf Attachment E policy	IC Document
AttachmentF.Pt12a.pdf Attachment F policy	IC Document
AttachmentF.Pt12a.pdf Attachment F policy	IC Document
AttachmentG.CEQ.pdf Attachment G policy	IC Document
AttachmentG.CEQ.pdf Attachment G policy	IC Document
AttachmentH.FedRegNEPA.pdf Attachment H policy	IC Document
AttachmentH.FedRegNEPA.pdf Attachment H policy	IC Document
AttachmentJ.Offsiteapp.pdf Attachment J	IC Document
AttachmentJ.Offsiteapp.pdf Attachment J	IC Document
AttachmentK.hmlsuseapp.pdf Attachment K	IC Document
AttachmentK.hmlsuseapp.pdf Attachment K	IC Document
AttachmentL.hmlsapp.pdf Attachment L	IC Document
AttachmentL.hmlsapp.pdf Attachment L	IC Document
AttachmentM.Revisions.pdf Attachment M	IC Document
AttachmentM.Revisions.pdf Attachment M	IC Document
AttachmentN.7.10.06FedReg.pdf Attachment N	IC Document
AttachmentN.7.10.06FedReg.pdf Attachment N	IC Document
HHS Public Health Application 5.2019.pdf Attachment I	IC Document
HHS Public Health Application 5.2019.pdf Attachment I	IC Document
HHS Title V application 6.2019.pdf Attachment K	IC Document
HHS Title V application 6.2019.pdf Attachment K	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Application Packets for Real Property for Public Health Purposes

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 40 CFR 1500-1508 45 CFR 12-12a (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-Application	No	Paper Only
Other-Application	No	Paper Only
Other-Application	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	2,500	2,500

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A policy		12/14/2016
Attachment B policy		12/14/2016
Attachment C policy		12/14/2016
Attachment E policy		12/14/2016
Attachment F policy		12/14/2016
Attachment G policy		12/14/2016
Attachment H policy		12/14/2016
Attachment J		12/14/2016
Attachment K		12/14/2016
Attachment L		12/14/2016
Attachment M		12/14/2016
Attachment N		12/14/2016
Attachment I		04/15/2021
Attachment K		04/15/2021

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

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