PHA Impact Follow Up - (RedCap form) (New form)

[NCEH] Environmental Public Health Tracking Network (Tracking Network)

Documents and Forms

Document Name Document Type
Form 0920-1175 PHA Impact Follow Up - (RedCap form) (New form) Form and Instruction
0920-1175 PA/PHA Impact Followup Att5G PHA Impact Follow Up - (RedCap form) (NEW instrument).pdf Form and Instruction
0920-1175 PA/PHA Impact Followup Att5G PHA Impact Follow Up - (RedCap form) (NEW instrument).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	PHA Impact Follow Up - (RedCap form) (New form)	Agency IC Tracking Number:	0920-1175

Is this a Common Form? No		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 and Instruction	0920-1175	PA/PHA Impact Followup	Att5G PHA Impact Follow Up - (RedCap form) (NEW instrument).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 37	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	74	74
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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