Information Collection

L1 Evaluation of Environmental Justice Facilitated Dialogue Program

IC 257627 under ICR 201911-1103-003 · OMB 1103-0117.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1103-0117 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
L1 Evaluation of Environmental Justice Facilitated Dialogue Program L1 Evaluation of Environmental Justice Facilitated Dialogue Program	Form and Instruction
L1 Evaluation of Environmental Justice Facilitated Dialo EJ_Facilitated_Dialogue_Program_Eval_Form-FINAL-12-14-2022.docx	Form and Instruction

IC Title:

L1 Evaluation of Environmental Justice Facilitated Dialogue Program

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 and Instruction	NA				Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	29	29
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.

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