Information Collection

Information collection for sample distribution

IC 221701 under ICR 201605-0648-003 · OMB 0648-0734.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Information collection for sample distribution	Form
List of places DWH sample availability announcement was posted.docx	Other-posting information
Sample request form DWH Sample Request Form_5-20-16_clean.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Form	NA	Sample request form	DWH Sample Request Form_5-20-16_clean.docx		Yes	No	Fillable Printable
Other-posting information			List of places DWH sample availability announcement was posted.docx		Yes	No	Printable Only

Line of Business: Natural Resources

Subfunction: Conservation, Marine and Land Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 75

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.