PFAS Exposure Assessment Technical Tools Feedback

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
AttA DCHI PEATT Feedback Email.docx Instruction
0923-0047 NCEH-ATSDR Srvc Dlvry Apprvl Frm PEATT Feedback v3 Trent signed.pdf Request for Approval IC Document
AttB PFAS Exposure Assessment Technical Tools PEATT May 2017.pdf Technical Tools IC Document
AttC PEATT Feedback RDF signed.pdf Non-research determination IC Document

Information Collection (IC) Details

IC Title:	PFAS Exposure Assessment Technical Tools Feedback	Agency IC Tracking Number:	0923-0047-17AXS

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
Instruction			AttA DCHI PEATT Feedback Email.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	0923-0047 NCEH-ATSDR Srvc Dlvry Apprvl Frm PEATT Feedback v3 Trent signed.pdf	07/25/2017
Technical Tools	AttB PFAS Exposure Assessment Technical Tools PEATT May 2017.pdf	07/25/2017
Non-research determination	AttC PEATT Feedback RDF signed.pdf	07/25/2017

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