Information Collection

ATSDR Safe Child Care Siting Survey

IC 216365 under ICR 201305-0923-003 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AttB ATSDR Safe Child Care Siting Survey (text).docx	Other-WORD
AttC ATSDR Safe Child Care Siting Survey (On-Line).docx	Other-Screen Shots
Att A_Email Invitation for ATSDR Safe Child Care Siting Survey.docx Att A. Email Invitation	IC Document
0923-0047 GenIC ATSDR Safe Child Care Siting Survey.pdf Request for Approval	IC Document

IC Title:

ATSDR Safe Child Care Siting Survey

Agency IC Tracking Number:

15AEL

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
Other-WORD			AttB ATSDR Safe Child Care Siting Survey (text).docx		Yes	Yes	Fillable Printable
Other-Screen Shots			AttC ATSDR Safe Child Care Siting Survey (On-Line).docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att A. Email Invitation	Att A_Email Invitation for ATSDR Safe Child Care Siting Survey.docx	04/30/2015
Request for Approval	0923-0047 GenIC ATSDR Safe Child Care Siting Survey.pdf	04/30/2015

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