FORM FOR REQUESTING SAMPLES

ICR 198305-2000-001

OMB: 2000-0139

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
137860 Migrated
ICR Details
2000-0139 198305-2000-001
Historical Active 198103-2000-004
EPA
FORM FOR REQUESTING SAMPLES
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/12/1983
Retrieve Notice of Action (NOA) 05/03/1983
  Inventory as of this Action Requested Previously Approved
04/30/1986 04/30/1986
5,000 0 0
400 0 0
0 0 0

LABORATORIES WILL USE THIS REVISED FORM TO REQUEST QUALITY CONTROL SAMPLES AND TOXIC/HAZARDOUS MATERIALS SAMPLES FROM EPA. THE FORM WILL ALSO ASSIST THESE LABS IN CONDUCTING QC SAMPLE PROGRAMS AS RECOMMENDED BY EPA.

None
None


No

1
IC Title Form No. Form Name
FORM FOR REQUESTING SAMPLES EPA-360, (CIN)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,000 0 0 0 5,000 0
Annual Time Burden (Hours) 400 0 0 0 400 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/03/1983


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