Information Collection

Attachment B NIEHS Simplified Data Collection Form 2017

IC 225552 under ICR 201701-0925-005 · OMB 0925-0657.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0657 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Attachment B NIEHS Simplified Data Collection Form 2017	Form
1 NIEHS Simplified Data Collection Form 2017 Attachment B NIEHS Simplified Data Collection Form 2017.docx	Form

IC Title:

Attachment B NIEHS Simplified Data Collection Form 2017

Agency IC Tracking Number:

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	1	NIEHS Simplified Data Collection Form 2017	Attachment B NIEHS Simplified Data Collection Form 2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	40	40
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.