Information Collection

NGWA_Intervention to Prevent Exposure to Contaminants in Drinking Water

IC 215642 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C_Instrument.docx	Other-WORD
1 NGWA-EVAL-SSA.docx Supporting Statement A	IC Document
2 NGWA-EVAL-SSB.docx Supporting Statement B	IC Document
A_Preliminary Results.docx Att A_UOI-Online Assessment Results Table	IC Document
D_Project Overview.docx Att D_Project Overview	IC Document
E_Invitation Email.docx Att E_Invitational Email to Participants	IC Document
F_Reminder Email.docx Att F_Reminder Email	IC Document
G_Confirmation In-person Interview.docx Att G_Confirmation of In-Person Interview E-mail	IC Document
H_Confirmation Telephone Interview.docx Att H_Confirmation of Telephone Interview Email	IC Document
B_Results PPT.ppt Att B_UOI Online Assessment Results (ppp)	IC Document

IC Title:

NGWA_Intervention to Prevent Exposure to Contaminants in Drinking Water

Agency IC Tracking Number:

15TK

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			C_Instrument.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	1 NGWA-EVAL-SSA.docx	03/11/2015
Supporting Statement B	2 NGWA-EVAL-SSB.docx	03/11/2015
Att A_UOI-Online Assessment Results Table	A_Preliminary Results.docx	03/11/2015
Att D_Project Overview	D_Project Overview.docx	03/11/2015
Att E_Invitational Email to Participants	E_Invitation Email.docx	03/11/2015
Att F_Reminder Email	F_Reminder Email.docx	03/11/2015
Att G_Confirmation of In-Person Interview E-mail	G_Confirmation In-person Interview.docx	03/11/2015
Att H_Confirmation of Telephone Interview Email	H_Confirmation Telephone Interview.docx	03/11/2015
Att B_UOI Online Assessment Results (ppp)	B_Results PPT.ppt	03/12/2015

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