Information Collection

PrivateWells

IC 228895 under ICR 201604-2080-002 · OMB 2080-0083.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2080-0083 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2521ss07 PrivateWells Survey.docx	Other-Other
2521ss07 PrivateWells Justification.docx 2521ss07 PrivateWells Justification	IC Document

IC Title:

PrivateWells

Agency IC Tracking Number:

2521.07

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
Other-Other			2521ss07 PrivateWells Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,000	1,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2521ss07 PrivateWells Justification	2521ss07 PrivateWells Justification.docx	11/02/2017

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