Camp Lejeune Drinking Water Notification Registry

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0703-0057 can be found here:

Documents and Forms

Document Name Document Type
Form No number - online Camp Lejeune Drinking Water Notification Registry Form
No number - online Camp Lejeune Notification Registry form Camp Lejeune Notification Registry-form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Camp Lejeune Drinking Water Notification Registry	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	No number - online form	Camp Lejeune Notification Registry form	Camp Lejeune Notification Registry-form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	170	170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.