Community Drinking Water Monitoring Form

Environmental Public Health Tracking Network (Tracking Network)

OMB: 0920-1175

IC ID: 222532

Information Collection (IC) Details

View Information Collection (IC)

Community Drinking Water Monitoring Form
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1175 Community Drinking Water Monitoring Form Att4c_CommunityDW_Form_2020.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

30 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30 0 0 0 0 30
Annual IC Time Burden (Hours) 3,000 0 -600 0 0 3,600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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