Community Members - Sign-In Sheet

ATSDR Communication Activities Survey (ACAS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0055 can be found here:

Documents and Forms

Document Name Document Type
Community Members - Sign-In Sheet Form and Instruction
ATSDR Public Meeting Sign-In Sheet AttE Sign-in Sheet.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Community Members - Sign-In Sheet	Agency IC Tracking Number:

Is this a Common Form? No		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
Form and Instruction	NA	ATSDR Public Meeting Sign-In Sheet	AttE Sign-in Sheet.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-19-0001 - Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances	FR Citation: 53 FR 30702

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	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.