Emerging Issues for Private Wells - CSTE Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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.