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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.