This survey instrument was designed to collect information about the range of public health activities performed in local communities and the array of organizations that contribute to these activities. The instrument was designed as a self-administered questionnaire to be completed by administrators of local health departments and/or their designees. Ideal respondents are individuals who serve in senior administrative positions within local public health agencies and who have broad, general knowledge about the types of public health activities performed by their agencies and by other organizations within the community. The survey instrument was based on twenty indicators of local public health system performance developed by Dr. Bernard J. Turnock (University of Illinois--Chicago), Dr. C. Arden Miller (University of North Carolina at Chapel Hill) and colleagues through a series of studies on local public health practice sponsored by the U. S. Centers for Disease Control and Prevention (CDC) Responses to the instrument were analyzed using a standard methodology developed by the investigators. The twenty Turnock/Miller questions are preceded by a brief set of demographic profile questions and followed by a small number of organizational questions.