Information Collection

Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing

IC 210596 under ICR 201111-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0572 Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Cl ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean.docx	Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-5_Consumers ATSDR-Message-Testing_Attachment-5_Consumers.docx	Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-6_PublicHealthProfessio ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals.docx	Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-7_Communitymembers ATSDR-Message-Testing_Attachment-7_Communitymembers.docx	Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-8_Consent-Form ATSDR-Message-Testing_Attachment-8_Consent-Form.docx	Form and Instruction
HMTS Expedited Review Form_508 compliant_TO15 MessageTesting.pdf HMTS Expedited Review Form_508 compliant_TO15 MessageTesting	IC Document
ATSDR-Message-Testing_Attachment-1_Background-InformationClean.docx ATSDR-Message-Testing_Attachment-1_Background-Information	IC Document
ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members_clean.docx ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members	IC Document
ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals.docx ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals	IC Document
ATSDR Message Testing_Attachment -9_BurdenHours.docx ATSDR Message Testing_Attachment -9_BurdenHours	IC Document
ATSDR-Message-Testing_List-of-Attachments.docx ATSDR-Message-Testing_List-of-Attachments	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-5_Consumers	ATSDR-Message-Testing_Attachment-5_Consumers.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-7_Communitymembers	ATSDR-Message-Testing_Attachment-7_Communitymembers.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-8_Consent-Form	ATSDR-Message-Testing_Attachment-8_Consent-Form.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	28	0	0	0	0	0
Annual IC Time Burden (Hours)	20	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Expedited Review Form_508 compliant_TO15 MessageTesting	HMTS Expedited Review Form_508 compliant_TO15 MessageTesting.pdf	02/25/2014
ATSDR-Message-Testing_Attachment-1_Background-Information	ATSDR-Message-Testing_Attachment-1_Background-InformationClean.docx	02/25/2014
ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members	ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members_clean.docx	02/25/2014
ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals	ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals.docx	02/25/2014
ATSDR Message Testing_Attachment -9_BurdenHours	ATSDR Message Testing_Attachment -9_BurdenHours.docx	02/25/2014
ATSDR-Message-Testing_List-of-Attachments	ATSDR-Message-Testing_List-of-Attachments.docx	02/25/2014

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