Low Pressure Event Form - Ultrafilter and Grab Samples

Epidemiologic Study of Health Effects Associated with Low Pressure Events in Drinking Water Distribution Systems

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0960 can be found here:

Documents and Forms

Document Name Document Type
G.LPE Form (revised).docx Other-WORD
Justification for Change 9-26-14.docx Justification for Change IC Document

Information Collection (IC) Details

IC Title:	Low Pressure Event Form - Ultrafilter and Grab Samples	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			G.LPE Form (revised).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-01236 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62821

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	49	49
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification for Change	Justification for Change 9-26-14.docx	09/26/2014

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