Information Collection

Line Listing Environmental Engineer

IC 234243 under ICR 201811-0920-007 · OMB 0920-0960.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0960 Customer Contact Questionnaire Line Listing Environmental Engineer	Form
0920-0960 Customer Contact Questionnaire Q. Customer Contact.docx	Form

IC Title:

Agency IC Tracking Number:

0920-0960

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	0920-0960	Customer Contact Questionnaire	Q. Customer Contact.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance

FR Citation: 57 FR 62821

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	25	25
Annual IC Time Burden (Hours)	50	50
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.