Environmental Questionnaire and Checklist

BTOP-Comprehensive Community Infrastructure, Public Computer Center, and Sustainable Broadband Adoption Applications Requirements

Documents and Forms

Document Name Document Type
Environmental Questionnaire and Checklist Form and Instruction
Environmental Questionnaire and Checklist 0660.0031.Environmental Questionnaire and Checklist.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Environmental Questionnaire and Checklist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Environmental Questionnaire and Checklist	0660.0031.Environmental Questionnaire and Checklist.doc		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
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.