My Air My Health Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (New)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2010-0042 can be found here:

Documents and Forms

Document Name Document Type
2434ss12 My Air Survey.docx Other-Other
2434ss12 My Air Justification.docx 2434ss12 My Air Justification IC Document

Information Collection (IC) Details

IC Title:	My Air My Health Survey	Agency IC Tracking Number:

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
Other-Other			2434ss12 My Air Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 418	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	418	0	0	0	0	0
Annual IC Time Burden (Hours)	105	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2434ss12 My Air Justification	2434ss12 My Air Justification.docx	08/28/2012

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