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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.