Drinking Water Information Collection (Public Water Purveyors)

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0063 can be found here:

Documents and Forms

Document Name Document Type
Drinking Water Information Collection (Public Water Purveyors) Form and Instruction
Drinking Water Information Collection Form for Public Wa M_Att3c_WaterInfoCollec_WaterPurveyors_CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Drinking Water Information Collection (Public Water Purveyors)	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	n/a	Drinking Water Information Collection Form for Public Water Purveyors	M_Att3c_WaterInfoCollec_WaterPurveyors_CLEAN.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	140	140
Annual IC Cost Burden (Dollars)	3,331	3,331

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.