Information Collection

[OPHDST] Advancing Data for Public Health Action Partner Survey

IC 271851 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25AK [OPHDST] Advancing Data for Public Health Action Partner Survey	Form
Form 0920-25AK ADPHA Survey [OPHDST] Advancing Data for Public Health Action Partner Survey	Form
0920-25AK ADPHA Survey Att A - ADPHA Survey.docx	Form
0920-25AK ADPHA Survey Att A - ADPHA Survey.docx	Form
0920-1050 ADPHA Survey.docx GenIC Request	IC Document
0920-1050 ADPHA Survey.docx GenIC Request	IC Document
SSA_0920-1050_ADPHA Survey.docx SSA	IC Document
SSA_0920-1050_ADPHA Survey.docx SSA	IC Document

IC Title:

[OPHDST] Advancing Data for Public Health Action Partner Survey

Agency IC Tracking Number:

0920-25AK

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	0920-25AK				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		10/24/2024
SSA		10/24/2024

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

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