Form 0923-0060 Mod01-EHLR Basic Engaging with Your Community Knowledge

Mod01-EHLR Basic Engaging with Your Community
Knowledge Assessment

Page 1

Please complete the survey below.
Thank you!

Form Approved
OMB No. 0923-0060
Exp. Date 08/31/2022
ATSDR estimates the average public reporting burden of this collection of information as 5 minutes per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the
data/information needed, and completing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information including
suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office; 1600 Clifton Road NE, MS
H21-8 Atlanta, Georgia 30333; ATTN: PRA (0923-0060).
1)

My job title is:

Environmental Health Professional
Environmental Professional
Tribal Environmental Specialist
Planner
Municipal/Tribal Agency Official
Developer
Environmental Non-profit/Non-profit
Citizen/community member
Student in public health, environmental science,
planning, "STEM" discipline
None of the above

2)

In reference to the Engaging with Your Community
module, please choose all that apply:

Specifically useful for my work. If so, you can
describe how below (optional)
Quick refresher
Offers me knowledge about a topic I am less
familiar with
Gives me confidence to increase my skills in and
understanding of community engagement related to
land reuse sites
Motivates me to learn more about land reuse sites
and ways I can be engaged
Not needed for my work
None of the above
Other (please specify)

3)

If you selected "specifically useful for my work,"
above, please feel free to describe how here:

4)

If you selected "Other," above, please specify here:

02/04/2023 12:16pm

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