Information Collection

Environmental Information and Documentation Checklist

IC 189032 under ICR 201603-0915-002 · OMB 0915-0324.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0324 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Environmental Information and Documentation Checklist Form
1 1 environmental_checklist.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Environmental Information and Documentation Checklist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	1	environmental_checklist.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,350	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,350	-497	1,847
Annual IC Time Burden (Hours)	1,350	-35	1,385
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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