Examining the Use of Climate Change Health Indicators by Health Departments in Adaptation Planning

ASPE Generic Clearance for the Collection of Qualitative Research and Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Document Name Document Type
0990-0421Attachment A_Climate_Change_II_Webinar_Guide (2).docx Other-guide
0990-0421SSA_Climate Change and Health_OMB generic.docx Support statement A IC Document
0990-0421SSB_Climate Change and Health OMB generic.docx Suppt st. B IC Document
0990-0421OMB Cover Sheet_CC and Health Indicators.doc Memo IC Document
0990-0421Attachment B_Climate_Change_II_Webinar_Consent_Form.docx consent form IC Document

Information Collection (IC) Details

IC Title:	Examining the Use of Climate Change Health Indicators by Health Departments in Adaptation Planning	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
Other-guide			0990-0421Attachment A_Climate_Change_II_Webinar_Guide (2).docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Support statement A	0990-0421SSA_Climate Change and Health_OMB generic.docx	04/01/2016
Suppt st. B	0990-0421SSB_Climate Change and Health OMB generic.docx	04/01/2016
Memo	0990-0421OMB Cover Sheet_CC and Health Indicators.doc	04/01/2016
consent form	0990-0421Attachment B_Climate_Change_II_Webinar_Consent_Form.docx	04/01/2016

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