Information Collection

Filter Holder Log

IC 186177 under ICR 201107-1601-001 · OMB 1601-0006.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 9500 Filter Holder Log	Form
DHS Form 9500 Filter Holder Log DHS Form 9500.pdf	Form

IC Title:

Filter Holder Log

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DHS Form 9500	Filter Holder Log	DHS Form 9500.pdf		No		Paper Only

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 522

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	190,008	190,008
Annual IC Time Burden (Hours)	3,173	3,173
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.