Information Collection

Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/

IC 206906 under ICR 201401-2900-002 · OMB 2900-0800.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0800 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-10066 Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/	Form
VA Form 10-10066 Open Pit Burn Registry Web-accessible Self-Assessment/Qu Form 10-10066_Open Burn Pit Self-Assessment 10-22-13.pdf To be determined	Form

IC Title:

Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	VA Form 10-10066	Open Pit Burn Registry Web-accessible Self-Assessment/Questionnaire	Form 10-10066_Open Burn Pit Self-Assessment 10-22-13.pdf	To be determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

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	0	0	0	0	0	0
Annual IC Time Burden (Hours)	0	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
No associated records found

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