Information Collection

Emerging Issues for Private Wells - CSTE Assessment

IC 215977 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⚠️ Notice: This information collection may be referencing outdated material.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
Emerging Issues for Private Wells - CSTE Assessment	Form
EMerging Issues for Private Wells - CSTE Assessment Att B_Instrument_Web version.docx	Form
Emerging Issues for Private Wells - Word Att A_Instrument_Word.docx	Form
PWCSTE-SSA.docx Supporting Statement A	IC Document
PWCSTE-SSB.docx Supporting Statement B	IC Document
Att C_Invitation E-mail.docx Invitation Email	IC Document
Att D_Reminder E-mail.docx Reminder Email	IC Document

IC Title:

Emerging Issues for Private Wells - CSTE Assessment

Agency IC Tracking Number:

15VC

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
Form	none	EMerging Issues for Private Wells - CSTE Assessment	Att B_Instrument_Web version.docx		Yes	Yes	Fillable Fileable
Form	none	Emerging Issues for Private Wells - Word	Att A_Instrument_Word.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

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	55	55
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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