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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.