Information Collection

Community Members - ACAS Online

IC 224873 under ICR 201612-0923-001 · OMB 0923-0055.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community Members - ACAS Online	Form and Instruction
ATSDR Community Activities Survey - Online AttF2 ACAS_Online Survey 06122017 clean.docx	Form and Instruction

IC Title:

Community Members - ACAS Online

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 and Instruction	NA	ATSDR Community Activities Survey - Online	AttF2 ACAS_Online Survey 06122017 clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances

FR Citation: 53 FR 30702

Number of Respondents: 19

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	5	5
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.