LPE Form and Samples (Pilot)

Epidemiologic Study of Health Effects Associated with Low Pressure Events in Drinking Water Distribution Systems

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0960 can be found here:

Documents and Forms

Document Name Document Type
LPE Form and Samples (Pilot) Form
LPE Form OMB Appendix L Low Pressure Event Form.docx Form

Information Collection (IC) Details

IC Title:	LPE Form and Samples (Pilot)	Agency IC Tracking Number:

Is this a Common Form? No		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
Form	none	LPE Form	OMB Appendix L Low Pressure Event Form.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 09-20-01236 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 252

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	2	2
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.