Community Assistance Panels Nomination Form

ICR 200103-0923-001

OMB: 0923-0007

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
7202
Migrated
ICR Details
0923-0007 200103-0923-001
Historical Active 199802-0923-001
HHS/TSDR
Community Assistance Panels Nomination Form
Extension without change of a currently approved collection   No
Regular
Approved without change 09/06/2001
Retrieve Notice of Action (NOA) 03/27/2001
This Information Collection Request is approved for three years. When ATSDR resubmits the ICR for renewal, it should update the wage rates used to calculate costs to respondents.
  Inventory as of this Action Requested Previously Approved
11/30/2004 11/30/2004 09/30/2001
150 0 1,200
25 0 200
0 0 0

ATSDR is mandated to prevent or mitigate adverse human health effects and diminished quality of life resulting from the exposure to hazardous substances into the envionment. To fulfill mission, the Agency conducts varied public health activities with communities nationwide whose members reside or work near hazar- douse waste sites. To facilities data collection, community cooperation and understanding, and health education, ATSDR some- times established "Community Assistance Panels" (CAPs) at these communities. This proposal requests a three-year extension on the nomination form and process ATSDR uses to establish CAPs.

None
None


No

1
IC Title Form No. Form Name
Community Assistance Panels Nomination Form

  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 150 1,200 0 -1,050 0 0
Annual Time Burden (Hours) 25 200 0 -175 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.
03/27/2001


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