Information Collection

Resident Air Quality Monitoring

IC 204431 under ICR 201210-0920-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Resident Air Quality Monitoring	Form and Instruction
Air Quality Monitoring Protocol Att 11A_Protocol for Air Monitoring.doc	Form and Instruction
Air Quality Monitoring Protocol - Spanish Att 11A-1(s)_Airborne Particle Data Diary_9 12 2012 .docx	Form and Instruction
Att 11A-1(e)_Airborne Particle Data Diary_9 12 2012.doc Data Diary - English	IC Document
Att 11A-1(s)_Airborne Particle Data Diary_9 12 2012 .docx Data Diary - Spanish	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Air Quality Monitoring Protocol	Att 11A_Protocol for Air Monitoring.doc		No	No	Paper Only
Form and Instruction	none	Air Quality Monitoring Protocol - Spanish	Att 11A-1(s)_Airborne Particle Data Diary_9 12 2012 .docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Diary - English	Att 11A-1(e)_Airborne Particle Data Diary_9 12 2012.doc	09/27/2012
Data Diary - Spanish	Att 11A-1(s)_Airborne Particle Data Diary_9 12 2012 .docx	09/27/2012

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