NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Ind. and Households)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Ind. and Households) Form
1 PEPH Aware Act Use Survey PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx Form
Fast Track _PEPH Ind. and Households.docx PEPH Ind. and Househould Fast Track IC Document

Information Collection (IC) Details

IC Title:	NIEHS Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (Ind. and Households)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	PEPH Aware Act Use Survey	PEPH_Aware-Act-Use_Survey_Final_06-20-2018v3.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 292	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	292	292
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PEPH Ind. and Househould Fast Track	Fast Track _PEPH Ind. and Households.docx	06/21/2018

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