Quality Control (QC) Sample Request Form

ICR 199506-2080-002

OMB: 2080-0016

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
140080 Migrated
ICR Details
2080-0016 199506-2080-002
Historical Active 199208-2080-001
EPA/ORD
Quality Control (QC) Sample Request Form
Extension without change of a currently approved collection   No
Regular
Approved without change 08/15/1995
Retrieve Notice of Action (NOA) 06/26/1995
EPA should delete the OMB address from the burden disclosure statement on the form.
  Inventory as of this Action Requested Previously Approved
08/31/1998 08/31/1998 10/31/1995
4,000 0 0
600 0 700
0 0 0

This form is a revision of EPA Form No. 360, OMB Control No. 2080-0016. It will be used by Federal, state, local, university, and private laboratories to assist them in conducting their quality control programs and as a result, support the Quality Assurance Program of USEPA for its regulatory and monitoring programs.

None
None


No

1
IC Title Form No. Form Name
Quality Control (QC) Sample Request Form ICR-941.05

  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 4,000 0 0 4,000 0 0
Annual Time Burden (Hours) 600 700 0 -100 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
06/26/1995


© 2024 OMB.report | Privacy Policy