Information Collection

Community Members - Sign-In Sheet

IC 224871 under ICR 202012-0923-001 · OMB 0923-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community Members - Sign-In Sheet	Form and Instruction
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx	Form and Instruction
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	n/a	ATSDR Public Meeting Survey Sign-In Sheet	AttE ACAS Sign-in Sheet 20201130.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

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	125	125
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	107	107

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.