Information Collection

Environmental Information and Documentation Checklist

IC 189032 under ICR 201904-0915-001 · OMB 0915-0324.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0324 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Environmental Information and Documentation Checklist	Form
0324 - Environmental Checklist (tracked).docx	Other-tracked
1 0324 - Environmental Checklist.docx 0324 - Environmental Checklist.docx	Form

IC Title:

Environmental Information and Documentation Checklist

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0324 - Environmental Checklist.docx	0324 - Environmental Checklist.docx		Yes	Yes	Fillable Fileable
Other-tracked			0324 - Environmental Checklist (tracked).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	150	1,350
Annual IC Time Burden (Hours)	1,500	150	1,350
Annual IC Cost Burden (Dollars)	0	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.