Information Collection

Field Work Check-Out Report (indiv)

IC 242260 under ICR 202006-1024-002 · OMB 1024-0236.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1024-0236 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-741D Field Work Check-Out Report (indiv)	Form
10-741D PERMITTEE FIELD CHECK-OUT REPORT Form 10-741D_Permittee Field Work Check-Out Report.pdf	Form

IC Title:

Field Work Check-Out Report (indiv)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 36 CFR 2.1 and 2.5

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	10-741D	PERMITTEE FIELD CHECK-OUT REPORT	Form 10-741D_Permittee Field Work Check-Out Report.pdf		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	80	-320	400
Annual IC Time Burden (Hours)	13	-54	67
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.