Information Collection

Waterborne Disease Prevention: State Program Assessment

IC 218357 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment B-Interview Guide.docx	Instruction
WDP-CAP-SSA.docx Supporting Statement A	IC Document
WDP-CAP-SSB.docx Supporting Statement B	IC Document
Attachment A-List of States.docx List of States	IC Document
Attachment C-Introductory Email.docx Intro email	IC Document
Attachment D-Email Reminder.docx Reminder email	IC Document
Attachment E-Confirmation Email.docx Confirmation email	IC Document
Attachment F-Follow up email.docx Follow-up email	IC Document

IC Title:

Waterborne Disease Prevention: State Program Assessment

Agency IC Tracking Number:

15BGO

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
Instruction			Attachment B-Interview Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

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	28	28
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	WDP-CAP-SSA.docx	09/28/2015
Supporting Statement B	WDP-CAP-SSB.docx	09/28/2015
List of States	Attachment A-List of States.docx	09/28/2015
Intro email	Attachment C-Introductory Email.docx	09/28/2015
Reminder email	Attachment D-Email Reminder.docx	09/28/2015
Confirmation email	Attachment E-Confirmation Email.docx	09/28/2015
Follow-up email	Attachment F-Follow up email.docx	09/28/2015

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